Preamble

The House met at Half past

Two o'Clock

PRAYERS

Mr. SPEAKER: in the Chair]

Orders of the Day — NATIONAL HEALTH SERVICE BILL

Order read for resuming Adjourned Debate on Amendment [Ist May] to Question [3oth April], "That the Bill be now read a Second time," which Amendment was, to leave out from "That", to the end of the Question, and to add instead thereof:
this House, while wishing to establish a comprehensive health service, declines to give a Second Reading to a Bill which prejudices the patient's right to an independent family doctor, which retards the development of the hospital services by destroying local ownership, and gravely menaces all charitable foundations by diverting to purposes other than those intended by the donors the trust funds of the voluntary hospitals; and which weakens the responsibility of local authorities without planning the health services as a whole."—[Mr Willink ]

Question again proposed, "That the words proposed to be left out stand part of the Question "

3.38 p.m.

Colonel Stoddart-Scott (Pudsey and Otley): In the course of this Debate we have heard that this is a good Bill, and we have also heard that it is not so good. We have heard that it is a progressive Bill, and we have also heard that it is not It all depends on what is meant by a good Bill and what you intend it to do, and what you mean by progress. Some people think that the further they get away from their home at night the more they are getting on and being progressive. I, myself, take the view that the nearer I get to my own homestead and my family, the more progressive I am. It you think that a good Bill is one which gives you a full-time medical service, which can without any further legislation provide that service, and which gives also a nationalised hospital service, then you are right in assuming that this is a good Bill. Time alone will show whether it is a good Bill or a bad Bill.
In no part of this House is there any wish not to have in this country, at the very earliest moment, a comprehensive health service, but this Bill does not provide a comprehensive health service. As the House knows, we have under the Education Act a health service to deal with school children. We know that there are


four other major Government Departments which have their own medical services, and the hon. Member for North Islington (Dr. Haden Guest) even suggested last night that the Colonial Office and the India Office, which have their own medical services, should, at some future date, come into a comprehensive health scheme. There are no less than 17 Government Departments which have their own health schemes, and this Bill does not attempt in any way to coordinate them.
Neither is it a health Bill in itself, for it does not attempt in any positive way to set out a health scheme in this country. It is purely a hospital service or a medical service Bill, a Bill for the treatment of disease. In fact, it is only in Clause 16 of the Bill, in six brief lines, that there is any positive health provision; that is where the suggestion is made that the Minister should have powers to conduct or assist research in this country into the prevention and curation of disease—powers which, I believe, the Minister already has without that one Clause in this Bill. I should like to suggest to the Minister that he should take powers not only for the prevention and curation of disease, but also to deal with the causation of disease. Until we know, for instance, what the causes of rheumatism and cancer are we cannot attempt either to prevent or to cure them. I hope that when we get to the Committee stage we shall be able to add the word "causation" to that Clause, so that physiological research and other research such as experimental pathological research can go on at the same time.
Indeed, one of the pieces of preventive medicine, the very first we had in this country, which has been so successful in almost stamping out disease, is abolished by this Bill. That is compulsory vaccination. We find here a Bill which coerces the medical profession, which coerces hospitals and local authorities; yet the Minister is not prepared to coerce the general public in some small way, to their benefit, by insisting that vaccination shall remain compulsory. Nor does this Bill carry out a suggestion which has been made again and again by the medical profession and even by the Minister's own Party, that the Minister of Health should be Minister of Health only, and should devote the whole of his time to the health of the community, and not

spread it over housing and so many other things. I believe this Bill contravenes one of the promises of the Labour Party in their Election manifesto, "Let Us Face the Future," in which they said that if they were returned to power, they would set up a Minister of housing to deal with housing alone. Here, instead, we have the Minister carrying on both housing and health at the same time, and giving five minutes only of his time each day to considering the health of the people and spending the rest of his time in stopping people building houses.
I am not going to address the House as a doctor or as one from a teaching hospital staff, because I believe this Bill is one which affects the people of this country, and it is the people we want to think about, rather than hospitals, or any other interested body. What do the people of the country think about it? I spent the Recess in my constituency and two large cities in the West Riding of Yorkshire into which my constituency protrudes, and I found that there are very great anxieties on certain counts. Many of these anxieties are probably unnecessary, and I hope the Minister or the Lord Privy Seal, who is to reply, will abolish some of those anxieties, as I am sure he can. I believe that the first anxiety arises because people dislike the fact that their doctors would appear under this Bill to be employed by the State. The Parliamentary Secretary spoke yesterday of the State service. If we are to have a State service it must be manned, in my view, by State servants; and it is only right and proper that those people who have been used to looking upon their doctors as employed by themselves, and responsible to themselves only, should show anxiety when they find that doctors are to be employed by the State and are to be responsible to some statutory body set up by the State, which takes its orders from regulations issued by the Minister. They see in this, some method by which the Government are to control certification. They realise very well that under the present panel system someone who is sick receives 15s. a week sickness benefit for 26 weeks, which, after 26 weeks, is reduced to 7s. 6d. But under the new National Insurance Bill a man with two children sees he will receive £3 2s. 6d. for an unlimited number of weeks on the certificate from a doctor, and he does not


like to think there should be anything in this Bill which would make his doctor less independent and fearless than previously with regard to his certification, This may be a wrong impression, but I think this impression is built up on the following facts.
The Labour Party's policy, as published at Blackpool, clearly indicated—and we heard it again yesterday—that it was in favour of a full-time salaried medical service, and the Minister himself, in one of his first statements, spoke about a doctor's remuneration being substantially a basic salary. In the White Paper he speaks about the remuneration being part basic salary and part capitation, with a diminishing capitation fee. I should like the Minister who is to reply, to explain why it should be a diminishing capitation fee. Why should it be two for a penny and three for two pence? There is no explanation in the Bill or the White Paper why it should be a diminishing capitation fee. But in his Second Reading speech which, I hope he will permit me to say was, in the view of many of us on this side of the House, a very statesmanlike speech, the right hon. Gentleman spoke of the capitation being the main source of the doctor's remuneration. I want to ask the Minister if he has changed his mind with regard to the doctor's remuneration, because there have been no negotiations, he has told us, with the doctors. I think he has also told us there are to be no negotiations of any kind before the Committee stage or before the Third Reading of the Bill. Why has he changed his mind? Is it because of the findings of the Spens Committee? We all know that the Spens Committee have finished sitting. It is generally known that the Spens Committee have submitted their report—

The Minister of Health (Mr. Aneurin Bevan): That is not correct. The hon. and gallant Gentleman must not accuse me of telling untruths to the House. The Spens Committee have not yet reported.

Colonel Stoddart-Scott: I must apologise if I conveyed to the House the impression that the Minister was untruthful, but he did say it was not "fully available"—

Mr. Bevan: Certainly. The report is not available until all the members have reported.

Mr. Willink (Croydon, North): Does the right hon. Gentleman mean he has received a majority report and not a minority report? What does he mean by "not fully available"?

Mr. Bevan: I doubt very much whether I am entitled to reply to that. The Government are asked whether the report is available. My answer is that it is not available. There is no partial report of a Select Committee. There may be a minority. There may be a majority report and three or four minority reports. There is no report available from the Committee until the whole report is available. As soon as the report is available, I will publish it.

Sir Wavell Wakefield (St. Marylebone): But does the right hon. Gentleman mean by the word "fully," that it is available or not?

Mr. Bevan: It is not.

Sir W. Wakefield: Then why say "fully"?

Colonel Stoddart-Scott: That clarifies my position. It is not available. The right hon. Gentleman told us on Tuesday he had not got the Committee's full report. Now we have the explanation. I think the anxiety of people with regard to their doctors arises also because this Bill prevents the buying and selling of the goodwill of a practice. In his Second Reading speech, the Minister called it an evil in itself, tantamount to the sale and purchase of patients, and, on a previous occasion, he described the buying and selling of medical practices as profound and indefensible immorality. There is no immorality in buying and selling medical practices, any more than there is in buying and selling the goodwill of a legal or dental practice. If there is immorality in it, I must ask the Minister to consider that the present Prime Minister and the present Lord Privy Seal both put their signatures to the previous Coalition White Paper, which intended to carry on this supposed "immorality." If it is immoral to buy and sell medical patients, it is equally immoral to buy and sell dental patients, and this Bill makes no effort to stop that. The only reason the Minister has given for stopping the buying and selling of medical practices, is that to do so will help in the even distribution of medical practitioners. If that is the


reason, then I say there is no better way of having an even distribution of medical practitioners than by having a 100 per cent. scheme, whereby you can detail how many patients each doctor can have. By that method, we can have an even distribution of practitioners throughout the whole of the country. I believe, if we have this negative direction, that we shall be compelling disgruntled doctors, with angry wives, to go to places where they do not wish to practise, and create in the medical profession Bevan boys, such as we had in the mines during the war.
The buying of practices has never been that financial burden around the neck of a young man as we have heard it described. You have only to think of the many thousands of poor Scotsmen who have come down to this country to start here, who have never gone into the bankruptcy court, and who have never gone back to their own country. A medical man, from the day he qualifies, can go into a decent sized practice, and, by paying off the purchase price of that practice over a period of 12 years, can secure for himself, during the whole of that time, no less than £700 per year. This has never been a drawback. The drawback to men going into medicine is the medical education. That is the bottleneck which has prevented people from becoming doctors. I believe that this £66 million of the taxpayers' money is going to be thrown away, in order that this bit of party politics can be introduced in this Bill. It would be better used if it were spent on providing a cheaper medical education.

Mr. Alpass: rose—

Colonel Stoddart-Scott: I have waited 20 years to come here to speak on this subject and I hope the hon. Member will forgive me if I do not give way, as my time is limited. I believe that men and women are anxious because, in this Bill, there are great dictatorial powers given to the Minister. Much greater powers are given to the Minister, I think, than he needs or wishes. One has only to glance through some of the Clauses of this Bill to see what tremendous powers he has. I know that nobody in this House minds that the present Minister, with his eloquence and enthusiasm which endear him to us all, should have these great powers, but he will not always be the Minister of Health. He has held the job of Minister

of Health and Housing for nine months, and in medicine and obstetrics nine months is a very significant period. It is the period of gestation, and if he does not produce more houses quickly, and a better medical service, I am sure the people of this country will dub him not only sterile, but impotent also. When we realise that the next Minister of Health may be—who knows?—the hon. Member for West Fife (Mr. Gallacher), it is right and proper that the people should be anxious about some of the powers which are given to the Minister in this Bill. It is possible, under Clause 43, for the Minister to send to any part of the country an unqualified man to practise medicine, and it is possible for the Minister to displace a doctor and send an unqualified man in his place. In another part of the Bill, he has power on the Central Health Services Council, and on the Executive Council, to vary the Constitution as he likes, and so all that excellent proportion which has been prepared and made between the profession and the local authorities can be completely wiped away if the Minister wishes. In Clause 2 (3), there is no number stated. I think that that is a very serious thing, because a Minister could pack the members of these regional hospital boards to the extent that no one who had any knowledge of the running of the great hospital system was on the board. There never was a more undemocratic method of choosing a body. In Clause 35, the Minister has power to prosecute. He can prosecute a doctor years after he has left his private practice and come into the State scheme, if he sells his house or surgical instruments to another doctor. Under Clause 34 (9), even a son who follows his father is precluded from making any financial assistance to his father and mother, even if they are in need.
May I now say a word about our health centres? This is a very useful suggestion. I think it was made by Lord Dawson's Committee, which sat in 1920. The Minister, in his speech, indicated that health centres of different kinds will be set up in different localities. The only criticism which one can make, is that he gives the local health authorities the statutory duty to set up these centres. Therefore, where you have a small health authority, like Rutlandshire or some small county council, it is their duty to set


them up without having some overhead body, like the regional hospital board, to decide where these centres shall be established. I think it would be much better if we could have some control, perhaps from the Minister himself. One heard it said in this House—I believe it was by the hon. Lady the Member for North-East Leeds (Miss Bacon), who to our regret is ill and unable to be in her place today—that these health centres give a great opportunity for group practices. There are no virtues in group practices, and there are no advantages to be obtained by them alone, unless you have the aids to diagnosis—X-ray, pathology and all those other things. I am sure that the Minister will have heard those famous words of Lowell:
A single doctor, like a sculler plies. The patient lingers, then slowly dies. But two physicians, like a pair of oars, Shall waft him swiftly to the Stygian shores 
To bring together an accumulation of doctors in a rural area, will have only one result: patients will have further to go and longer to wait for medicine and for documents You will lose some of that confidence which has been built up between the doctor and the patient. It will introduce into medical practice an institutional type of medicine, and an outpatient atmosphere will be created. The personal contact and the personal touch of the doctor in his home will be lost.
People are truly anxious, too, about the State ownership of hospitals. I think that there is no one who disagrees with the Minister that the time has now come when voluntary hospitals cannot exist on voluntary contributions, whether they are the big contributions or the work-people's contributions. Once it became necessary to introduce large weekly national insurance contributions, the 2d. and 3d. a week of the voluntary hospital system became quite impossible. Is it necessary because the Minister or the Government finance an institution up to 100 per cent.—be it a university or a school—that they must physically own it, and not just control it? I think that is a principle on which we must decide, and against which we must fight. Regional hospital boards for the overall planning of our hospital system are excellent. I, personally, regret that they do not also plan where the situation of the health

centres should be. I should like to ask the Minister, or the Lord Privy Seal, who is to reply, if it has yet been decided which regions are to be based on which universities, because it does seem that there are extraordinarily large regions for planning. When we realise that from Bristol you may have to plan for the whole of Somerset, Dorset, Devonshire, Cornwall, and probably part of Wales, and from Sheffield, South Yorkshire, Lincolnshire, Derbyshire, Nottinghamshire and Leicestershire, it is apparent that some of the personal touch is going to be taken away in the very remote areas.
I think, too, that there is anxiety about the endowments of the hospitals. It is wrong to say that endowments are only moneys given by wealthy people, now deceased, much of which came from the Exchequer. There are many endowments which have come from the shillings and pence of working-class people, and many endowments, now held by hospitals, were given for specific purposes by people who are still alive. I hope that the Minister will consider whether some of those cannot remain for the specific purposes for which they were given. May I give two examples? In the city of Bradford, there is a magnificent hospital, which has just built a fine radium clinic. It is one of the largest and first in the Kingdom and has been built by the shillings and pence of the citizens of Bradford to celebrate the Coronation of our present King. That institution, which is not a teaching hospital, will lose its endowment, and although its management had the enthusiasm and initiative to think and plan for the future, and to be a pioneer in this health service, it will, if the Minister's intention is what it appears to be, have its endowment taken from it and transferred to some other part of the country.
In my own constituency, at Ilkley, there was a hospital with which the citizens were very dissatisfied. Before the war, they collected sufficient money to build a new hospital and bought a piece of land on which to build it immediately after the war. It would be tragic if those people, who had worked so hard, and who had planned and schemed for the future, had no opportunity of building their hospital. I see that the Minister is


shaking his head; I hope that means that my view of the matter is wrong.
This Bill can, without any extra legislation, create a State monopoly in dentists, specialists, doctors and hospitals. It has certain good qualities, and I hope that we may be able to improve other parts of it, but we cannot get away from the fact that it is an untidy Bill. In my view, it menaces the obstetric and midwifery services, and I hope that we shall be able to get some improvement in the plans for those services before the Bill becomes an Act. It is an insincere Bill, because it does nothing for positive health, and gives no assurance to the people that the hospitals will generally reach a higher standard. It does a certain amount of harm to the doctor-patient relationship, and the service it proposes is in no way a free health service, as has been stated, because every individual will have to pay £3 a year for this service. I do not think that you can call it a free service, when, although many people, for long periods, will have no doctors' bills or hospital bills, yet they will be called upon to pay £3 per head per year. The Minister has a great opportunity, and I hope that he will take it. If he does, he will go down, in my view, in the history of medical progress with Lister, Lloyd-George and even Banting and Fleming. I hope that he will have the disposition to preserve more of the good qualities in our present services and, at the same time, the ability to improve those that are not up to a high standard.

4.7 P.m.

Mr. Hardy (Salford, South): I am very grateful for the opportunity to say a few words, and I hope that I may claim the indulgence of Members for this, my first, effort in this House. I cannot claim, like the previous speaker, that I have waited for 20 years to get my piece across, but I have been particularly concerned, for a longer period than 20 years, with the subject to which I am going to refer. I think that we all appreciate that this proposal, which the House is now discussing, is most revolutionary, and one which was encouraged and requested from this side of the House for many years.
I want to make a special plea for the ambulance services. I have been a member of a local authority for a great number of years, like many other Members

in this House, and I remember the days, particularly the old days of the boards of guardians, when anyone who could drive a horse was engaged to be an ambulance driver. That did not apply only to one part of the country. In many places, that was the practice in those days. I agree that, since the passing of the Local Government Act, 1929, when the guardians went out of existence so far as the county boroughs were concerned, there has been a great improvement in the ambulance services. But there is plenty of room for further improvement. I have believed, for many years, that we have never placed a real and true value upon the ambulance services. I have known people who have been appointed without any experience, knowledge or qualifications as ambulance drivers, and many of them are doing that work today. Those are not the type of people we want to be bound up with this Measure. If it was right during the war to nationalise the fire services, with a view to saving life, surely there cannot be anything wrong in nationalising the ambulance services. I understand that, in many towns, that was effectively done under one regional control, and that Plymouth had a very fine ambulance service during the war.
There is, however, a danger under this Measure. Clause 27 allows local authorities to retain the authority to control the ambulance services. This gives those authorities the right to employ contractors to do the work instead of having it done by an experienced and qualified ambulance service. In private practice there have been cases where a private car was used as an ambulance, and was not fitted for the job, and had no particular equipment. A youth whose hands were thick with oil and grease has been sent to remove patients from a house to a hospital. I think that that is a practice that ought not to be encouraged at all. I am perfectly satisfied that the Minister, if he will only look at this matter, will realise its importance, in the saving of life, because we are convinced that inadequate ambulance services for many years in many parts of the country have been responsible for loss of life. We can safeguard against that, if the Minister will only agree to take the same view of the importance of the ambulance services, as he is taking of the medical and hospital services.


Other people in this House are more concerned with the buying and selling of medical practices. My object in saying these few words is to ask the Minister to have a look at this question, with a view to bringing about a unified ambulance service, under the control of the regional authority which is to be responsible for the hospitals. We shall be grateful if he will do so and the public at large could appreciate the fact that at last this Government have appreciated the value of the Cinderella of the health services in this country.

4.12 p.m.

Sir Wave11 Wakefield (St. Marylebone): I am sure I am speaking on behalf of the whole House when I say how pleased we are to have heard the hon. Member for South Salford (Mr. Hardy) make his maiden speech. During the Debate on this Bill we have had many maiden speeches, and I think it has been characteristic of all the speakers, without exception, that they have spoken from the heart, and invariably with knowledge of their subject. It seems to me that if that same experience and knowledge are brought into the Committee stage this Bill may emerge, in its final form, a better Bill. We hope we may hear the hon. Member again on many occasions.
When the Minister moved the Second Reading of this Bill he said that he hoped it would bring higher standards into the medical profession, and that it would be a great contribution towards the wellbeing of the common people. He concluded his address in moving words, and I feel encouraged by his approach to the Bill to believe that if constructive suggestions could be made in the Committee stage he would give them his most sympathetic consideration. After all, the purpose of hon. Members on all sides of the House is to consider how best can the public be served. Other speakers have already said this but it should be said again and again. I feel that under this Bill as it now stands, the public in many respects will not be better served but rather they will be worse served. I think it is absolutely tragic that a Measure which is supposed to have as its basis and foundation the report of Lord Dawson, and in the preparation of which the doctors have given their help in the past two decades, should be

opposed as it is now by an almost united medical profession.

Hon. Members: No.

Mr. Bevan: indicated dissent—

Sir W. Wakefield: The Minister shakes his head and hon. Members say "No, no," but it is a fact that the medical profession are united against it. They feel deeply that the public will not be better served by this Bill as it now stands. In the very brief time at my disposal I am going to give reasons why I believe this to be the case. The first reason is that the privately owned surgeries of today are to disappear and health centres will take their place. The intimacy of the private surgery will go and people will not be able to go round the corner to see their practitioner. They will have to go to the health centre where there will be group practice and many doctors. That will mean that patients will have longer distances to travel. In these health centres there will he formalities, the keeping of records and the loss of any personal, intimate relationship, and this, I think, will result in a worsening of personal service. The doctors will be there in group practice, and the Government cannot convince me that under a State service doctors will be willing to go out in the middle of the night. They will come to these health services from nine to five and then go home. There will be a duty doctor with duty typists and secretaries. When people ring up and notice is given of urgent cases, I do not believe that the same personal service will be given under this State service as is available now, when practitioners are responsible directly to their patients and not paid by the State, as envisaged in this scheme. That is my view and that is the view of many people with whom I have discussed this Bill. Furthermore, because there is no good will—

Mrs. Middleton: rose—

Sir W. Wakefield: I have only three or four minutes left and but for that I would gladly give way to the hon. Lady. Because there is no goodwill to maintain, I feel that there is going to be a much more impersonal and less personal service. There is any amount of evidence available on that point. Doctors and dentists during the period of the war went into the Services and had an opportunity of seeing the State service and the private



and personal service. One and all say that there is not the same personal regard for patients in a State service that there is in a personal service. There is no use hon. Members shaking their heads. I have got plenty of evidence on it, but I have not the time to give it now. When we come to the Committee stage I hope an opportunity will be given me to prove what I am saying now. As a result of this Bill there will be less quality in the entrants in the medical service. There will be a removal of enterprise, a removal of the taking of risks and responsibility and the carrying out of what a doctor believes to be right in the interests of his patients.
I say this for certain reasons and I am going to give two examples. During the war a young doctor organised a certain service magnificently. He put 60 patients into a place where there should only he 50 beds according to the regulations. A reprimand came through to headquarters in connection with his action. It so happened that, quite accidentally, a distinguished surgeon was there when the reprimand came through to headquarters. He said that that young doctor ought to be highly commended instead of reprimanded for his action. But the doctor was reprimanded because he did not follow the regulations, and instead exercised his right of initiative in the best interests of the patients. In my own constituency a patient was injured by an anti-aircraft shell. Quick work on the knee by a doctor resulted in the knee being saved. That was contrary to the written regulations, and as a result there was a reprimand.

Mr. McGhee: What regulations?

Sir W. Wakefield: If the hon. Member wishes I will give him the date of the incident, the name of the medical practitioner and the precise particulars of the case to which I am referring. What is at the back of all this? Merely this, that in the human relationship between doctor and patient, risk must be taken. It is individual and it is personal, and rules and regulations cannot be laid down by the Minister to cover all those varied, individual instances of attention which are so necessary in the doctor-patient relationship.
It is because I believe that there will be this fundamental alteration in the

relationship between doctor and patient that I submit that doing away with the voluntary principle in our great hospitals, with the exception of the teaching hospitals, will be a retrograde step. I believe there will be an undoubted loss in the spirit of service and voluntary help which has been so vital a characteristic of the life of our nation for hundreds of years past. I deeply fear that this Bill, instead of being a great Bill which could immeasurably improve the health of our people, will not lead to the better service and better health which the Minister and everyone wants for the great majority of our people. I deeply regret it, and I hope that before it passes on to the Statute Book Amendments will be made which will remove its grave blemishes, and will make it the kind of Bill which the Minister and all of us want to see made law.

4.21 p.m.

Lieutenant William Griffiths (Manchester, Moss Side): It is with great pleasure that I rise today, during the early part of May, which has, for our Labour movement, such special significance, to welcome this Bill, which has so much Socialist content. In the very first Clause an obligation is placed upon the Minister to provide, in the health sense, to "each according to his needs." This is a cardinal Socialist principle, and is welcomed by everybody on these benches. To those of my colleagues who feel that some of the concessions which have been made by the Government rather cut across the far-reaching Socialist plan which some had in mind, I would say that we must remember that the Government have to face up to this position as they pass through each stage of the progressive change-over from the social order which we did not create, but with which we have to grapple, and turn into the Socialist society that we want.
I was particularly impressed by that section of my right hon. Friend's speech on Tuesday, in which he drew a clear distinction between consultation and negotiation with outside groups of health workers. When a Bill of this kind is before the House there are many pressure groups at work outside, and I think the Minister is to be congratulated on resisting those sectional interests. After all, our main interest is the interest of the community; the Bill must be a good one for the community. Often, the advice we


receive from sectional interests outside is advice given only from their own point of view. In this respect, I would like to refer to a recent meeting of health workers in the city of Manchester, which was attended by a local official of the British Medical Association. At that meeting, one of the Socialist doctors in the audience was dealing with the Association's appeal for £25 from each doctor towards the fighting fund set up to resist the Bill, and was claiming that little support had been received. We were very interested to hear from the representative of the B.M.A. at that meeting that, although he admitted that doctors in the main had not contributed to the fund, nevertheless, extensive financial contributions had been received from outside bodies. This was an indication that the elements represented by hon. and right hon. Members opposite are not specifically interested in health matters, but fear any legislation which is introduced by this Government, and are willing to back any movement to try to discredit this Government.
My particular reason for intervening today is because I am a member of a profession—I am a consulting optician—which is vitally affected by this Bill. In general, we welcome the Bill and we feel that we have a very important part to play. On Tuesday, however, my hon. Friend the Member for Edge Hill (Dr. Clitherow) raised some specific questions concerning my profession, one being the definition of the status of sight-testing opticians, which is not clear in the Bill. I hope that the right hon. Gentleman who winds up the Debate will deal with that point. My right hon. Friend the Minister made a good point on Tuesday when he said he believed that doctors and professional people on the local executive councils, by their participation in administration, were epitomising democratic control in the best sense. I welcome that, but I would point out that sight-testing opticians are not represented on the local executive councils. On the basis of my right hon. Friend's statement, that he wished professional people to take part in administration, I ask the Minister to give consideration to the claim of sight-testing opticians for representation.
The optical practitioner was promised in the White Paper, but is not promised in this Bill, proper professional status. We

need an assurance from the Minister on what is meant by that term. By the Bill, the Minister could easily relegate the valuable profession of optical practitioners to a purely menial and auxiliary position. This seems to be supported by the fact that no provision is made for representation on any advisory or other committee, beyond that of the temporary ophthalmic services committees, which are to be abolished as soon as the clinical scheme is considered adequate. The optical profession fear that with the abolition of these temporary committees, the total abolition of the profession might well follow. In the public interest, therefore, I would like the Minister to give us an assurance about our exact status in the scheme and, above all, an assurance that we shall have adequate representation on the appropriate committees. I feel it may well appear that I have been making a very sectional appeal today. That is true, but only to the extent that I feel a case has been made out whereby, without any sacrifice of the warm welcome we give to the Bill, we nevertheless feel that we have a very definite part to play.

4.29 p.m.

Sir Ernest Graham-Little (London University): I opposed the proposals of the Coalition White Paper on the Health Service two years ago for the same reason that I am opposing this Bill today, except that my opposition now is stronger. I am opposing it because my profession is overwhelmingly resistant to it, especially that part of the profession—the consultant section—for which I a m most qualified to speak. The present Bill differs from the Coalition White Paper in a vitally important matter, namely, the nationalisation of hospitals. The Government claim to have a mandate from the country for a bewildering number of projects, but the nationalisation of hospitals was nowhere mentioned in the programme of any Socialist candidate, and no claim can be made that the country has given a mandate for this Measure. The nationalisation of hospitals, as I propose to show, concerns particularly the consultant section of the profession, and that section has already shown practically universal opposition to the proposal. Socialist candidates and the Socialist Party have made most extravagant promises to the people to supply the fullest measure of specialist and institutional treatment, treatment which was not supplied by the National


Health Insurance Acts now in operation. I have even heard of an optimistic charwoman, deluded by these promises, who expressed her confident expectation that she would now be able to call in Lord Horder whenever she wished. [HON. MEMBERS: "Why not?"] It would be difficult even for the party opposite to supply Lord Horder to every one of 47,000,000 people who might want him.

Mr. Percy Wells (Faversham): Why is it always a charwoman who labours under this illusion?

Sir E. Graham-Little: I have promised to be brief in my remarks, and I cannot be brief if I take up every interruption. I shall follow the precedent established yesterday by the Parliamentary Secretary, who persistently refused to give way to anybody except an ex-Cabinet Minister.
In a speech in April, 1943, the Lord Chancellor enunciated the very wise axiom that "if you get a scheme which men think is not fair, that scheme is broken at the start " The present position with regard to the Education Act is an example of the truth of that axiom. The teachers were grievously affronted by several of the conditions imposed by that Act. The result is that there are now 24,000 fewer teachers in the schools than there were in November, 1944. A series of teachers' conferences which have been held during the last week have shown that that development has continued and is increasing in force. The net result will be that when, as the Government have decided, the school leaving age is raised on 1st April, 1947, there will be 400,000 additional pupils, but there will be fewer than 200,000 teachers, as the Minister of Education has confessed. What does that mean? There is a general consensus of opinion among educational experts that a minimum of from 300,000 to 350,000 teachers is required to ensure any satisfactory fulfilment of the Education Act. When 1st April, 1947, comes, there will be at most 180,000 teachers in the schools. I submit that the Education Act has already broken down. Can the Minister of Health improvise doctors in the same way as the Minister of Education is trying to improvise teachers? I think not.
Consultants spend at least ten years in their training, chiefly in voluntary hospitals, and subsequently spend a great

part of their time as honorary members of the staff of those hospitals. I have spent 50 years of my life in the closest association with a great voluntary teaching hospital, first as a student, then as a teacher, and finally for 32 years as head of a department. The voluntary hospital is the life of the consultant. It attracts to its service those men and women who are deeply interested in the scientific practice of medicine and in research. It offers this attraction because it offers complete freedom. That freedom will vanish with this Bill That this is fully realised by the consultants was, I think, shown quite incontestably by the facts that were placed before the House on Tuesday last. There are three Royal Colleges—physicians, surgeons and obstetricians—who are qualified to speak for the consultants. They are so qualified because the vast majority of consultants belong to one or other of those bodies. I happen to be at the moment the only Member of the House who is also a Fellow of the Royal College of Physicians, and I can confirm the statement that was made on Tuesday last by my right hon. Friend the Member for South Kensington (Mr. Law) as to the reaction of the physicians. I was present at the meeting on 15th April, and I can confirm what my right hon. Friend said. That meeting, which was one of the largest I have ever attended in 40 years as a Fellow, resolved, by an enormous majority—again, one of the biggest majorities I have ever known—to refuse the motion approving the transfer of the ownership of hospitals which had been proposed by the President. That was the reaction of the College of Physicians. The College of Surgeons were even more emphatic in their opposition to nationalisation. The College of Obstetricians was, I think, a little misrepresented in the speech of my right hon. Friend the Member for South Kensington. I have before me the resolution which was passed by the College of Obstetricians; it was furnished to me by the President of the College, and it reads:
Hospital ownership: That if the ownership of hospitals passed to the State, the College would urge, (a) that the composition and power of the regional boards must be satisfactory from a medical aspect" —
That it is not so satisfactory has been shown, I think, in the speeches from these Benches—


(b)that every hospital should have its own committee and management"—
Again, that is denied by the Bill—
(c)that the endowments of each hospital should be returned to the same hospital for its own use.
Perhaps the most serious result of these proposals for the hospitals will be the mortal injury which nationalisation will cause to the prosecution of medical research which, for the last 100 years, has come almost exclusively from the voluntary hospitals. I believe that no other hon. Member who has spoken has drawn attention to this result. I wish to draw the attention of the House to one of the gravest reproaches to be made against the Bill, namely, the ludicrously meagre reference to research. Nine lines of the Bill, in Clause 16, deal with medical research, but 140 lines, in Clause 35, are devoted to devising a number of savage punishments for the doctor who wishes on his retirement to introduce to his patients a successor to his practice, and who accepts a modest premium for exercising that good will Let us see what the Bill says on the subject of medical research. I will quote from the statement in the White Paper, and the White Paper everywhere seeks to give the most favourable interpretation of the Clauses of the Bill. The first sentence strikes me as being rich in humour. It reads:
The Minister is also expressly empowered by this Bill to conduct research"—
that is, medical research. One might, I submit, as reasonably introduce a Bill expressly empowering the Minister of Health to navigate the "Queen Mary" from Southampton to New York. How diametrically opposed is this conception of medical research dictated from Whitehall to the procedure adopted at voluntary hospitals which have been the sources of medical advance. This procedure, which has produced results that have placed Britain in the very vanguard of advance in the science and practice of medicine, owes its success to the complete freedom which it gives to the staff. Our method is to pick a good man—and voluntary hospitals attract the best men and women—and when found to turn him loose in the wards or the laboratory as the case may be. The idea of directing research from a State Department appears ridiculous to one who has been trained in the voluntary hospitals tradition. As I have said, the man chosen

is let loose in the wards or the laboratory and is not subject to any other restriction except that he comes up for reappointment every three to five years, the period varying in different hospitals.
May I cite an example from my own medical school, St. Mary's, where I have been on the staff for 32 years? Forty-three years ago the school decided to ask Almroth Wright, a brilliant Irish graduate who had done notable work as professor of pathology at the Army Medical School at Netley, to institute a new department at St. Mary's. He had had no previous connection with St. Mary's Hospital; his election disproves the contention made by speakers opposite that hospitals always elect their own pupils to the staff. I also was elected to the hospital staff of St. Mary's as a complete outsider from another hospital. Sir Almroth Wright was elected, and he founded the Institute of Pathology which includes the Department of Inoculation. That department very speedily secured an international reputation. Wright's development and perfection of the methods of vaccine-therapy had as its first result the elimination of typhoid fever as one of the principal causes of mortality in the armies of the world. The application of that system has resulted in the comparatively complete removal of that dreadful disease. Wright did much more than that. He established a great school of research and one of his disciples, Sir Alexander Fleming, with the discovery of penicillin has made an advance which, I think, has been quite justly compared to the epoch-making discovery of antiseptic surgery by Lister at a voluntary hospital, the Glasgow Infirmary, of which we had a very moving description by my colleague and friend the hon. Member for the Scottish Universities (Sir J. Graham Kerr) last Tuesday. If the Bill is passed this prosecution of medical research will be killed.

4.45 P.m.

Mr. Stokes (Ipswich): Much as I should like to take up some of the points made by the hon. Member for London University (Sir E. Graham-Little) I must ask him to excuse me if I refrain from doing so and ignore the normal course of Debate in view of the great time limitation. I have risen in order to seek clarification from the Minister on one particular aspect of the Bill. In doing so I speak on behalf of the Roman Catholic denomination in


this country, though I believe I should be right in saying that I am probably expounding the views of all those who have run and founded sectarian hospitals. May I make it perfectly clear that we welcome the Bill and want to make it work, but at the same time we wish to receive some assurance from the Minister that the principles for which we stand shall be properly safeguarded in the management and administration of our voluntary hospitals when they are taken over. I should also like to make it clear that we particularly welcome the Bill because the many millions of people who are of our denomination in this country are for the most part the poorest people, and we believe that under the Bill very great benefits will accrue to them when it becomes fully operative.
There is one point I would stress. We do not seek for a single moment to ask that Catholic hospitals should be provided serviced only by Catholic nurses and doctors, but we know, as every thinking man knows, that vital issues are at stake and that matters concerning the natural laws are involved. All we seek is to see that the moral principles for which we stand are properly safeguarded. May I remind the Minister that many of these sectarian institutions were founded purposely in order that the patients going to them should be able to maintain the customs and principles of their faith? We ask simply that if we cannot be given the same rights and guarantees as the teaching hospitals have under the Bill, we shall receive some specific assurance from the Minister—I hope when he winds up the Debate—that the atmosphere and character of our hospitals shall remain the same, and that, in order to achieve this, steps will be taken to provide in the Bill or in the Regulations that the management committees shall be of the same constitution and shall be given the charge of the administration of the hospital. We do not resist for a moment the idea that the regional committees will have supervision over them, but we do ask that their atmosphere and the character shall be maintained.
The only way we can see the principles for which we stand being assured in the administration of the hospitals is for the committees to remain in the main as they are. If the Minister wants to appoint his own nominee to the committees we have no objection.

Mr. Montague (Islington, West): Would the hon. Gentleman be a little more explicit? What does he mean by the atmosphere of these hospitals?

Mr. Stokes: I cannot go into the medicinal differences that exist in certain practices, but there are, for instance, the question of birth control and that of abortion. It happens that the Catholic laws in regard to abortion are much the same as the law of the land, but the law of the land is sometimes not observed. In particular, we have hospitals serviced by nursing sisters, nuns, and we feel it highly desirable that the administration committees of these hospitals shall remain in the main of the same character as they are at the present time.
In conclusion, I should like to say this in support of my contention. The hon. and learned Gentleman the Member for Montgomery (Mr. C. Davies) said yesterday, with regard to charity, that the danger would be that when hospitals were handed over and nationalised the people's willingness to give would dry up. There is a misconception. People mix up "charity" with "generosity." I do not conceive that it is a right method of conducting society that the welfare of people should be dependent upon the willingness or otherwise of other people generously to contribute to their welfare. By all means let them contribute if they want to, but the welfare of the others should not be dependent upon it. My conception of charity is that we should so order our affairs that people have the best of all the possible chances of service, in all conditions. It is because the Bill greatly improves the facilities and provides better conditions than have ever been afforded to the masses of the people of this country, that I welcome it.

4.51 p.m.

Mr. Gerald Williams: During the Debate we have heard many specialists and experts, but in the few moments available to me, I want to return to fundamentals, and to get down to the words of the Amendment. I wish to add my voice to those which have spoken for the continuance of the voluntary hospitals. My reason for doing so is that it is unnecessary to do without them The voluntary hospitals have led, in the treatment and diagnosis, as well as in the prevention, of diseases. They are prepared to satisfy the Minister now, that


is to say, they are prepared to comply with standards to which they will have to conform and are prepared to have his inspectors down to see that they carry out these standards that the Minister wishes. They are prepared to have patients sent to them by the Minister and to receive payment for them. They will then become self-supporting. Then we shall still have the same hospitals, run by local management, which is what the people want, rather than dictatorship from Whitehall.
The system of voluntary hospitals at the present time is that they run their affairs from year to year. At the end of the year they have an annual meeting and an annual report. The report is sent out for people to look at and discuss. Then the people can come to the annual meeting to criticise. That is democracy. The people are able to throw the managers out if they do not like what the managers are doing. That is what we consider to be real democracy. Many people are proud to serve on those boards. It is a great honour to serve there, and local residents are stimulated to further voluntary effort by the thought that they may be rewarded by managing one of those hospitals one day. To do away with this system is once more to take away the enterprise that has made this country what it has been in the past. Under the Bill, the local management committee will not even have control of their own staff. They will not appoint their own staff. That will leave them in a very peculiar position in regard to the management of the people they employ.
The trusts are to be taken over, and endowments are to be taken from the voluntary hospitals. In many cases the money was left by the dead. It is immoral to the highest degree to use that money for any other purpose than that for which it was left. Many people have been spurred on to greater efforts in order to be able to endow something which was after their own hearts. How many benefactors must be now turning in their graves at the thought of a Socialist Government administering those funds? [Laughter.] Yes, a sufficient number of people must be turning in their graves to be causing a small earthquake. It is robbery of the dead. It is easy for the Minister to say that he has more interest in the living than in the dead, but when

he comes to write out his own will, he will surely wish some regard to be paid to what he writes on that document. The dead are unable to be here to defend themselves. They are unable to demand their money back because it is being used for other purposes. The principle is wrong.
Another point about finance is that it is very desirable that the local management committee should be able to spend at their own discretion. The moment standard salaries, standard instruments and standard apparatus are laid down, initiative will be killed for the local people. The competition which exists today to make one's own hospital perhaps a little better than the one next door by means of local initiative will also be killed. Complaints will be coming in. Complaints there will surely be. The complaints will be local, and the management committees will be able to reply: "We receive our instructions from the regional board. We will pass the complaint on to them." The regional board will pass the complaints on to the Ministry. Dozens of letters will be written and dozens of files will be opened, and time will roll on. Probably no satisfact on from the complaints will be obtained in the end. Or even more likely, since the hospitals will be a Government concern, Members of Parliament will be worried in future by complaints, and will have to ask Questions in the House. The business of the House will then be held up even more than it is at present. The voluntary hospitals invariably settle the complaint on the spot. Vaccination has been mentioned. Under the Bill, people will be left to contract in, in order to be vaccinated. At the present moment anyone who does not wish to be vaccinated can contract out. That system has kept this country more free from smallpox than any other country in the world. Why can we not keep the system of contracting out, instead of introducing the system of contracting in?
Many hon. Members on this side of the House have regretted that terms under which the doctors will have to work have not been laid down which would have enabled the doctors more easily to say what they thought about the Bill. Hon. Members on both sides of the House expect their doctors to be responsible to them and not to the State. It is no use denying that in future doctors will be


civil servants, or very nearly civil servants. The ideal is to have your family doctor round to your own house, to have a chat with him, and to take his advice, and then to decide what you want to do. You may want to take a risk, even of dying, by having a very severe operation. Other people may be inclined to have a nature cure. A doctor who is under State instructions may be able to give neither, for the fear of the consequences. He will have to treat his patients according to the State formula, in case questions are asked about the results afterwards. Doctors and patients in this country up till now have been brought up on initiative. Patients will become disgruntled, and doctors will be discouraged as the result of this Bill, if they are to be forced to use nothing but Government prescriptions. Some bad doctors may be pleased at the thought of having a guaranteed salary whether they give good service or bad, but I still believe that there are many good doctors in this country for I have not met one so far who is in favour of the Bill.

5.0 p.m.

Wing-Commander Millington (Chelmsford): I am delighted to have caught your eye, Mr. Speaker, immediately after the hon. Gentleman who has just sat down, because of one phrase which he used in the course of his criticism of the Bill. He said that the dead are unable to come here and plead their case. I say that quite properly the case for the dead is being pleaded in this Debate by the natural successors of the dead, the Conservative Party. When this Bill was first printed I read it through—unlike somebody I heard speaking this afternoon—and not just the White Paper, and I felt deeply sorry for His Majesty's Opposition. The duty of the Opposition is to oppose, but unfortunately the Bill has been cast in a mould which reflects the will of the people of this country at the moment. The people of the country are happy about it, and the job of the Opposition is made correspondingly more difficult.
I want to refer to a speech for the Opposition made very briefly and rapidly by the hon. Member for St. Marylebone (Sir W. Wakefield). If the Conservative Party presumes to come to this place and to represent the interests of the doctors, let them have better advocates than this

hon. Member. He came in front of you, Mr. Speaker, and this House and accused the medical profession of a profligate disregard of their duties and responsibilities towards their patients. He said that he felt convinced that when this Bill becomes law doctors will not go out on an emergency case after their normal duty hours. He felt convinced that the patient would not get the same kind of service and attention under this Bill and under a State service as we now see in the present relationship. The tenor of the Opposition all along has been that the traditional relationship of doctor and patient, built up over 
centuries of private enterprise, is going to be disrupted and destroyed.
I would like to ask any who really feel this deeply whether they have been sick or disabled during the last seven years, in the Services, for example, and whether they have seen the unfortunate body of men who come round this House about twice a month and are receiving medical attention from the State at the rehabilitation hospital at East Grinstead. Do hon. Members of the Conservative Party dare to suggest that these disabled ex-Service men, who are receiving the best conceivable medical attention, the best that science can give them, would get better attention if they had a cash relationship between themselves and the doctor?
I welcome this Bill because I believe it is cast in the noblest mould of any Bill that has come before this House, at any rate, in the last 25 years. The first main reason why it should be accepted by all right minded and right thinking people is that it is a total Bill, under which everybody will qualify for equal benefit. That is the difference between this Bill and the Bill being piloted through Committee under the ægis of the Minister of National Insurance. There is no qualification whatever, other than that of being a citizen of Great Britain and of being in some medical distress. I welcome the Bill because of that broad human principle, that mould and concept in which the Bill is cast. I believe that sectional interests, as they are called, have been whipped up quite deliberately by people who stand to benefit personally by whipping them up and by politicians whose duty it is to oppose the Government in all its legislation, and that in fact the case has not been fairly presented to the rank


and file of the medical profession. The more they have the Bill in front of them, the more they are able to examine its Clauses, and the more they are able to understand where they as individuals are going to stand inside this new health system, the wider is their acceptance not only of the general broad principle, but of the ordinary detailed working of the scheme.
I was amused when listening to the Minister on Tuesday by what seemed to me a philosophical conflict in his mind. He referred to the organisations of the medical profession as vested interests—I believe I am quoting him correctly—but a little later, after he had mentioned the natural Socialist hostility towards vested interests interfering in the formulating of correct legislation, he also made it quite clear that there is another Socialist principle, that if we are to have democracy in industry—medicine is an industry—we must have a strong element of workers' control. So we have, on the one hand, doctors being treated by the Minister as vested interests, and, on the other hand, being treated as the workers in the industry and being allowed — and I welcome it — a very fair participation.
Participation—I ask doctors to remember this because, particularly in the much vaunted hospital services, they have never had it before. What has been the complaint from any young progressively minded doctor giving service in a provincial voluntary or provincial municipal hospital? He meets the other local doctors, and they decide that £3,000 or £5,000 spent on a certain piece of equipment would do the health of the neighbourhood immeasurable good. The doctors themselves, although they may make representations, are not directly represented on the finance committees of the majority of those hospitals, and it is the butcher, the baker and the candlestick maker who reject the claims of the doctors for financial assistance on the grounds that with the present system of raising money that amount of money, however great the need, cannot be raised. Now doctors will share the responsibility of allocating funds.
I want to raise two other points, one of which has been mentioned and one which has not, for the Minister's consideration.

The first is that, while it is true, as an hon. Member said a few moments ago, that the Minister has covered the whole question of medical research in a few lines in Clause 16, I would like him to give some specific hope that a positive impetus will be given to research into such grievous things as the incidence of cancer, tuberculosis, venereal disease, rheumatism and the like. The power in that small Clause rests in the hands of the Minister. He has the power now to grant money for research, but it would give pleasure and consolation to people who are themselves sufferers or who have near and dear relatives who are sufferers, if some positive word were given that it is the intention of the Minister to encourage research, particularly in these directions.
The other point is that I was surprised, knowing the mind from which this Bill emanated, to discover that the nursing profession is rather summarily dismissed in the short Clause 25, which says that local authorities are required, either through voluntary organisations or by directly employed nurses, to develop domiciliary nursing services. There is an organisation in this country with which the Minister must have been in contact, which is an excellent organisation for at least laying down the standard. That is what has been missing previously in district nursing—a standard, so that one can get the same kind of domiciliary nursing when one goes from one county to the next. The Minister will know that I refer to the Queen's Institute of District Nursing. I would make it clear that, in nursing in particular, standardisation must mean standardisation upwards, because of the lack of finance and of the administrative difficulties that the nursing profession has met, up to now, particularly in rural areas. I would suggest to the Minister that this organisation could lay down standards and examinations, and is well qualified to do the work of testing so that there will be an improvement in the status of the domiciliary nurse—an important part of preventive medicine, as I am sure he will agree—and so that we may see an influx of girls into this profession.
I end on a personal note. This is the first opportunity I have had to speak in this House since I made what is to me, but probably to nobody else, a very important political decision. I believe it is imperative, because of the economic con-


dition of this country, that everybody who has good will—particularly everybody who has followed the Socialist faith for any number of years—should give every support possible to the present Administration. I feel particularly that the Cabinet is demonstrating its faith in its principles and its high courage in bringing legislation of this character on to the Statute Book at a time when it might be excusable for it to put off the reorganisation and the expenditure until some future date Therefore, ten days ago I resigned from the party which heretofore I represented in this House and I would like, with your permission, Sir, to announce that in future I shall lose my unique position and be one of a vast horde amongst whom I shall be very proud to serve.

5.I2 p.m.

Mr. J. S. C. Reid (Glasgow, Hillhead): We have now come in this country to a time which gives us a great opportunity for a far-reaching advance in the prevention and treatment of illness. For a long time, for obvious reasons, it has not been possible to make progress. Now it is possible, and if I were asked to put the present position in a nutshells I would say that, at their best, our medical services in this country today are unsurpassed anywhere in the world. I would say that the average is very high but, on the other hand, there are a number of hospitals and other services which have really never had a fair chance and which are below standard, and there are a great many people who have not got full access to all services before illness breaks out, or in the early stages of their illness. Therefore we have to undertake a double task. We have to bring up to standard those services which are below standard, and we have very greatly to broaden the existing services.
We are all agreed about those aims. We have been agreed before the Election and since. What we are discussing this afternoon is the means of achieving those aims. How are we to expand the existing services so far as is necessary without losing any of their essential qualities? On that matter I agree entirely with the line taken by the White Paper of 1944, where it says near the beginning:
There is no question of having to abandon bad services and to start afresh. Reform in this field is not a matter of making good what is bad, but of making better what is good already.

That carries, I think, the assent of the Government as well as of ourselves. We are in a realm here where cold efficiency is not enough. We must remember that we are dealing with a profession which is more individualist in its outlook than any other, and rightly so, because the business of medical men is not merely to treat ailments; their business is to treat patients, patients with natural idiosyncrasies magnified by their illness in many cases. We must remember also that medicine is an art, and that art does not, in general, take kindly to regimentation. We must remember that the art of medicine has still long way to go before it reaches perfection, and that progress in the past has depended to a very large extent on individuals or small groups of men, men very often who would never fit in comfortably to any regimented system, and we must rely on men of that kind for future progress also.
Of course, we shall require more detailed, more elaborate organisation, but let us make it as unobtrusive as possible, let us make it as little rigid as possible. I was very much struck, as I am sure were all hon. Members who heard him, by the way in which the hon. Member for South Tottenham (Mr. Messer) dealt with this matter in his most impressive speech, and I think it worth while to refer for one moment to what he said. He divided the social services into two : those which affect people in the mass and those which affect the individual. He said with regard to the latter:
These are important not merely because of what is done, but because of the way in which it is done. They are inportant because you can get mechanical efficiency which still does not do all that is required."—[OFFICIAL REPORT, 30th April, 1946; Vol. 422, C. 140.]
Then he uttered a warning against uniformity. In this matter I think we should beware lest we lose the substance of the human spirit for the shadow of administrative efficiency. We are dealing in this Bill with an immense field. We are setting out, of common consent, to achieve a comprehensive service, comprehensive not only in the sense that it includes everybody—the Bill does that—but also in the sense that it includes all services—the Bill does not do that. Not that I make any special complaint of that, because it may be impracticable.
The Minister in his remarkable speech, if he will allow me to say so, sketched



existing deficiencies in some detail. I do not propose to traverse that ground because, broadly speaking, I agree with his diagnosis, but where I am afraid I part company with him is in his method of treatment, in the developments which he foreshadows. Unfortunately, I have no time to deal with the multitude of important matters which we shall have to discuss on the Committee stage. I cannot even enumerate them all—dentistry, eyesight, hearing, mental health, clinics, health visitors, home nursing, the school medical service—although it is not in the Bill, we must consider it—preventive and environmental services. All these matters will be discussed, I have no doubt, in a friendly and cooperative spirit in Committee, because we welcome the Minister's assurance that on all these points he is willing to consider Amendments on their merit, and I can assure him we shall take full advantage of his offer to do so. I trust that there will be no question of our having to hurry unduly when we come to the Committee stage. We have had nearly three days' discussion here. Obviously that is not too long, although I do not complain that it is inadequate. But there is a great deal which has not been even touched upon. I hope that upstairs we shall be able to discuss details adequately, but not excessively.
I propose to deal with two particular issues on which there really is a fundamental cleavage between us on matters of grave importance and, I think, of deep principle. The two matters to which I refer are the position of the general practitioners and their patients under the new scheme, and the position of the hospitals. In regard to the general practitioners, I believe that the vital thing for the patient's sake is that the general practitioner's loyalty should be solely to his patients and not in any respect to any service or to the State. I believe he should be responsible to his patients and to his conscience. If his patients believe in him he should need to fear no man, but if his patients do not believe in him he should not be able to fall back on official support to sustain him. That is the principle which ought to run through this matter, but it is a principle which I am afraid is gravely imperilled, as I shall show, by the provisions of this Bill.
We agree that the general practitioner requires more assistance. We agree that

he needs more diagnostic facilities We agree that there must be speedier access for his patients to specialists. We agree that in many cases he ought to have better access to new medical knowledge than he has. I do not think the Minister greatly overstated the matter when he spoke of the "loneliness" of medical practitioners. On the other hand, we are not altogether agreed about general practitioners' maldistribution. The provisions of this Bill in regard to general practitioners go very much further than is necessary to achieve the objects to which I have just referred, and in doing so they endanger most seriously the doctor's freedom and, therefore, they endanger the patient's interest.
I will deal in some detail with the question of maldistribution, because so much is made to hang on it, surprisingly much. We were given some figures, and I cannot help feeling that they are a little misleading. Not now, but later on, I will ask that we should have some information on this question. During the war, there was a very elaborate comb-out of doctors for the Services. If the maldistribution were as bad as has been alleged, one would think that hardly any doctors would have been taken from the under doctored areas and a great many from the over doctored areas. I have no figures, but I suspect that that was not quite so and that if we looked into particular districts we would find reasons which would go some way at least to explaining the apparent disparity and disproportion. I think that some time we should have some information about that. I do not want to claim that there was no maldistribution; no doubt there was, but that was at a time when only a part of the population were comprehended in the panel service.
Now we are to have 100 per cent. available under the new scheme for capitation fees. That being so, industrial areas will become attractive areas for doctors and it is only in the rural areas that there is likely to be much risk of under doctoring. I agree that there may well be a case for a basic salary in some of the rural areas. There may be some other difficult areas. I do not know, but if it turns out that there are, there would be a case for a salary. I believe that the proportion of areas in which a salary would be necessary to attract a sufficient number of doctors is comparatively small and it may be very small. To make a


basic salary general is wholly unnecessary and, on general principles, very objectionable. Indeed, there seems to be no reason for making it general, except that it paves the way for an ultimate adoption of a salaried service.
The next thing which hangs on maldistribution is the general power which is being taken to prevent the movement of doctors when it is alleged that any area is sufficiently staffed already, and to select which doctor may fill a vacancy in such an area. My reaction to this proposal is not only that it is objectionable, but that it is wholly unnecessary. It is unworkable. How is the quota to be arranged? Obviously, if this is to be worked out, it must mean that the committee which is working it has to decide that a certain area ought to have an establishment of 10, 12, five or six, or whatever the size of the area calls for. How is that number to be worked out? If it is done by population, one will get very much worse maldistribution than under the old system, but otherwise it can only be done by local investigation. Only one committee is being set up in the whole of England and Wales for this matter. It cannot be done, and if there were any necessity for it there would have to be much more elaborate machinery than is provided for in this Bill.
Surely the proper policy is not to seek to prevent doctors from going to certain places, but to make it attractive for them to go to the places where they are wanted. The whole of Labour policy is, as I understand it, not to prevent workers moving, not to direct them, but to attract them. That seems to me to be a much better way than the way which is proposed in this Bill. I cannot understand why it is not sufficient to attract the doctors to the under doctored areas by means of salaries or other inducements and to leave well alone otherwise. I cannot believe that the deficiency of the number of doctors in this country is going to be so enormous as to need anything more than the salary as an attraction where that may be required.
There is another serious objection to this proposal—there are many but I will mention one only. It will make partnership extremely difficult because the partner can no longer select his new partner. He will be foisted on him by the committee, and the "loneliness" of which

the right hon. Gentleman complained will, I am afraid, not decrease if this goes on. Finally, on this matter, there is the prohibition of the sale of practices It is very expensive and quite unnecessary if the power is not maintained to prevent people from going where they want. I suspect the real reason is not that it is made necessary by the power of selection—I will not call it direction; the real reason is because the right hon. Gentleman thinks, as he said on Tuesday, that it is an evil thing in itself. I do not propose to argue this matter fully; there is not time; but it occurs to me that that is an afterthought, for a great many of the right non. Gentleman's colleagues did not appear to think that quite recently, and he does not seem to think it now about dentists.
What happens when the practice is sold? In a great many cases a number of patients change to a new doctor before they even see the successor. If the successor does not prove to command confidence the practice vanishes in a surprisingly short time. Patients are very well able to exercise their right of choice, and therefore the objection which is commonly stated on the benches opposite really has no substance. This matter, added to what I said a moment ago, makes the maintenance of partnerships, and indeed the appointment of assistants, extremely difficult, because no man will know, in face of this elaborate penal condition in Clause 35, whether he is safe to make a partnership agreement, because he is liable to a £500 fine or three months' imprisonment if the consideration he gives to his new partner is substantially less than the partner's services
might reasonably have been expected to he worth.
What is to determine the meaning of that vague phrase? I ask the Minister, in this matter, to be willing to consider Amendments most carefully.
Turning to the question of health centres, I have the gravest doubt whether they will be acceptable to most patients. I believe that we should, wherever we can, give people what they want and not what we think they ought to have. Therefore, although I am quite prepared to agree that there should be experiment, and extensive experiment, in this matter, I beg the Minister not to launch out into a wholesale programme for the establishment of these centres until he has proved


whether or not they are what the patients want. Summing up the position, I want to see diagnostic facilities at a reasonable distance from the surgeries, I want to see cooperation, I want to see encouragement of partnership, not discouragement. I want to see refresher courses for general practitioners, which have not been mentioned. I do not think this Bill helps in that respect.

Mr. Bevan: It does indeed. I attach the utmost importance to refresher courses, and reference is made, both in the White Paper and the Bill, to the establishment of post-graduate medical courses.

Mr. Reid: I do not think the point of controversy between us attaches to that point. I hope I did not convey the impression that the Minister was against refresher courses. What I intended to say was that they are one of the things I want to see, and that they can be provided without the objectionable Clauses in this Bill. All the objects I have mentioned can be achieved without the objectionable parts of this Bill.
What will be the position under what I have called the objectionable Clauses? A doctor will have a basic salary. He will not have any goodwill of his own, he will not have any freedom of movement without the permission of a central committee, he will not have any surgery in many cases—all steps in the direction of a wholetime State service. This Bill, as has already been pointed out, enables the Minister to go, by regulation, at least nine-tenths of the way towards a full time salaried State medical service. How is the Bill to be used in this matter? The Minister's language in this matter was very instructive, because the Minister is a master of English, and knows how to introduce qualifications when he wishes to do so. He does not introduce them unnecessarily. In moving the Second Reading of this Bill he said. in regard to this matter:
Some of my hon. Friends on this side of the House are in favour of a full salaried service. I am not. I do not believe that the medical profession is ripe for it.…
A little later he said:
 Therefore, the main source at the moment through which a general practitioner will obtain his remuneration will be capitation."— [OFFICIAL REPORT, 30th April, 1946; Vol. 422, C. 55.]

That has given us fair notice that as soon as matters ripen, as soon as the conditions of this moment are past, we shall depart from this system in the direction of a full time salaried medical service. Therefore, let those outside this House who do not, perhaps cannot, because there is no room in the newspapers. follow our discussions in great detail, take note that the Minister is out for a full time salaried service as soon as he feels he can impose that upon the country.

Mr. Bevan: There is all the difference in the world between plucking fruit when it is ripe and plucking it when it is green.

Mr. Reid: Some people's ideas of ripeness vary tremendously. The Minister may prove to be an adept at forcing the plant. I ask the right hon. Gentleman to be specific about this. The policy of the Labour Party, as expressed in April, 1943, in their pamphlet "National Service for Health" was this:
In the Labour Party's opinion it is necessary that the medical profession should be organised as a national, full-time salaried, pensionable service.
Is that still Labour Party policy? It is of vital importance that we should know. The right hon. Gentleman can scarcely have any difficulty in answering that easy question. If he says "No" we shall welcome it. If he says "Yes," or if he does not say anything—because there could be only one reason for keeping silent—to what does that lead? The Parliamentary Secretary was very frank about this yesterday. He made it quite clear that freedom of choice and a whole time salaried service could not co-exist. There must be a choice between them, because if there is a full time salaried service the whole time men must obviously be fully occupied or fairly fully occupied, and if they are unpopular doctors they might be transferred to another area, but ultimately some patients will have to be found for them.
Obviously, we cannot keep freedom of choice with a full time medical service. The Parliamentary Secretary frankly admitted that. Is it, therefore, Labour Party policy that when the time comes we shall abolish freedom of choice, and shall see the Government attaching patients, against their will, to doctors who cannot attract patients for themselves? That seems necessarily to be implied in official Labour Party policy It is well


that the country should understand that. Of course, if the right hon. Gentleman can tell us that his party have had second thoughts on the matter and are not now going to support a whole time salaried service but are going to stop where the right hon. Gentleman said he would start, that is a different matter. I ask the right hon. Gentleman, therefore, to be extremely specific on this point.
I pass from that to the other branch of my remarks, which concerns hospitals. I start again by asking what is wrong with the present position. I think there are four heads under which any existing deficiencies may be grouped. There are some hospitals which are very bad because they are wholly out of date. They are largely local authority hospitals which have never had a proper chance for renovation or replacement. That is nobody's fault. Secondly, there are some small hospitals, which are rather too ambitious, I agree, although I think the right hon. Gentleman perhaps elaborated a little too much on that. They are not big enough to be fully independent. Thirdly, there is some unnecessary overlapping of services. The fourth and largest matter of all, I think, is that there are very many gaps which must be filled. What are mostly required for this purpose are money and time to build up the services.
We are all agreed that money is not to stand in the way. I am glad the Minister did not suggest that this is to be a free service. It is not. About one third of the cost is to be paid by the weekly stamp which we have all to use, and about two thirds of the cost will be paid by the taxpayer. It will cost a lot but it will be worth it. How are all these improvements to be organised? The doctors were pioneers in this matter. They gave us their views a long time ago. We believe there must be an organisation at regional level. We are not altogether in agreement about the size of the regions. We say it should not be an executive organisation. It should be a planning organisation. If it is made executive it is quite impossible for the men of standing we want to put on it to have the time to carry out the necessary work. Therefore, the necessary executive work must be left to civil servants or the like. That necessarily means that the executive work must be run by rules and controls with a certain amount of red tape. That cannot be avoided in a large region. 

The suggestion that planning cannot be divorced from execution is, in my view, without any substance at all. To begin with, the first planning will have to be done by a body which has never carried out any executive duties, a body which has come together for the first time. Why they should have to carry out the execution of their plan I do not know. Indeed, neither does the Parliamentary Secretary know because he told us yesterday that the proposal was to pass the execution over to smaller bodies in order to preserve the local character and interest. Does that mean that real control is to be passed over to the local committee? If so, it is quite new and very welcome information. On the other hand, does it mean there is to be some divided responsibility for execution, with part of the executive functions to remain with the regional body, and part with the local body? If that is the picture, it is about the worst possible set-up that can be imagined. I hope the right hon. Gentleman, again, will have second thoughts.
We say that the plan ought to settle local units. A large or medium-sized hospital, either by itself or with satellite smaller hospitals, would be a very appropriate unit. Hospitals which are too small to be a unit by themselves must, of course, be linked in some degree at least, and not necessarily all in the same way, with some other hospital in order to form an appropriate unit. We are all agreed about that, although I think the disadvantages of the small hospital can readily be exaggerated. Everyone here knows of small hospitals which have done their job admirably. There are certain difficulties. Let us not exaggerate them. We must preserve some measure of independence. Having got the unit, one then gets the board of governors. They must be an executive board of governors who have the responsibility for spending money and who can settle policy in that hospital. They may require to be broadened from their existing form. They may require to be set up in some way where there is a large group of municipal hospitals. A board is required with responsibilities which will attract men of standing. Then it is necessary to lay down the task which the unit has to perform. Minimum standards should be laid down and provision made for inspection and control, but the responsibility must be fastened fairly and squarely on


the shoulders of the board of governors of the local hospital. That is an essential and most necessary departure from the scheme outlined in the Bill. I hope that the right hon. Gentleman will think again about that.
I give one example of how I think that would improve matters We all know that the recruitment of nurses is extremely difficult. I ask the House to consider whether we are more likely to recruit the right type and number of nurses, if they can join a local unit with an individuality, tradition, and prestige, or if they have to join a regional or national service and to be subject to transfer here, there and everywhere. Surely, all experience shows that it is the unit with the tradition rather than the big national service which attracts nurses. In this matter we must avoid remote control. It is not so much a question of the ownership—although there is no reason for the change of ownership—it is the control by the local board of governors, which is the essential thing.
I pass to the subject of endowments. In the past endowments have been diverted from their original purpose only for one or other of two reasons, either because it would be wasteful to apply them to their original purpose, or because it is impracticable to apply them in that way any longer. Can anybody say that either of these tests could be satisfied with regard to the endowments with which we are dealing? Nobody has said so yet and I do not think anybody can say that. If that case could have been made it would have been the most obvious case of all. I do not want to pay too much attention to a phrase but I did not much like the right hon. Gentleman's phrase about "the caprice of private charity". I thought at least it was liable to misconception. Is it so very wrong that people should aid their ailing fellow men? Is it that all persons who are in need of assistance should derive that assistance solely from the taxpayers through the Government? There have been indications that some such idea as that was in mind, and I hope it is not really the view of the Government.
If it is not the view, there is no justification for what is being done with regard to these endowments. Is it suggested that the real reason is that there should be equality

all over? If that is the reason, then why leave the endowments of the teaching hospitals, and thereby defeat equality? If it is the idea to encourage people to make gifts to regions, whereby a rich region will not have equality with a poor region, then it is hopelessly illogical. If the Minister says that everything must be equal and uniform, then his Bill is all wrong. If he says that there is nothing wrong with teaching hospitals maintaining their endowments, why should not any other hospital also maintain its endowments? I hope that. here again, the right hon. Gentleman will realise that the argument is against him, and will give way.
Now a word with regard to the local authority hospitals. I could understand an argument for taking over the whole of the local authority public health services, though I should disagree with it. But I cannot understand on what principle of sanity the Minister is to split the public health services in two, with the hospitals under one regime, and all other public health services under another. The matter of maternity and child welfare has already been thrashed out. I refer to it only as the best example of the confusion which will undoubtedly occur if this proposal goes through. I find that even more alarming than the proposals themselves are the arguments by which they are supported. If the right hon. Gentleman's argument is right—I have not the time to read it from his speech on Tuesday—it applies with just as great force to education, and with almost as great force to many other local authority services. Does the right hon. Gentleman really mean that this is to be the beginning of the destruction of local democracy, because, if he really means his argument and intends to apply it logically, that is where it leads. We believe that local democracy should not be attacked in this way and that the Minister's argument is a thoroughly bad one. There is no difficulty in arranging the appropriate finance, if we have the good will to do so.
I would like to comment on the form of the Bill. Why is so much being left to regulations? Why is the House being asked to give the Government a blank cheque in matters of such enormous importance? Is the scheme ready or is it not? If the scheme is ready, why should the Government be afraid to put it in the Bill and tell us about it? If it is not ready, and it has proved so difficult to


get ready that it has not been decided yet, how can the Government tell us that this Bill is going to work? I think that even at the risk of some little delay, if this scheme is not ready, the Government ought to get their scheme into workable form before they come to this House to ask for its approval. Why is there all this centralisation and this preference for centralised power and bureaucracy against decentralised administration and responsibility? Is it just grasping after power, or is it some belief that uniformity and efficiency are same thing? I cannot see any third reason to justify this aggregation of powers and duties at the centre, and I hope the right hon. Gentleman will be able to tell us why the Government have adopted this highly bureaucratic, and, indeed, totalitarian, method of approach. The idea seems to be that we must all keep in step, and that nobody is to move forward in one step of progress, until all can move together. If that is so, it is a thoroughly bad idea.
In conclusion, may I say it is with the greatest regret that I find myself compelled to vote against this Bill? The Bill could have done so much. Agreement was so nearly reached. The provisions, threshed out with the help of the medical profession and others, were so nearly adequate, that it was really unnecessary for the right hon. Gentleman to introduce what he has introduced.

Mr. Bevan: Oh.

Mr. Reid: I cannot think of any other reason why so much has been cast away except political motives. If the Government pursue this course, if the Minister persists in this idea that he always knows best, I am afraid that we, on this side of the House, must mark what we think the loss of a very great opportunity by our votes in the Lobby tonight.

5.57 P.m.

The Lord Privy Seal (Mr. Arthur Greenwood): We have listened to an exhibition of logic-chopping which has not added much to the argument, and I am bound to say, at the outset of my speech, how sorry I feel for the Opposition. They have been in office so long that they are now in a semi-comatose condition. The position which they are now facing is a position in which they have a good deal to learn I have never known an Opposition so feeble on so

great an issue as the Opposition has been in this Debate. I say that this is a great Measure. Had I, in 1929, as Minister of Health in a minority Government, had the majority which is behind me today, I would have introduced a Measure on these lines with the greatest pleasure and enthusiasm.
Hon. Members seem to think—and a good many of my right hon. and learned Friend's points were directed to this—that this Bill is something final. Labour policy is never final. [Laughter.] Yes, I know the policy of the Opposition is final, but it is dead. This is a developing policy, and my right hon. Friend, as soon as this Bill is on the Statute Book, will, in collaboration with the medical profession, about which hon. Members opposite seem to have so low an opinion, and with the hospital authorities, establish a partnership to work out in detail how this great Measure is to operate in the years to come. The Minister is under no illusion that, once the Bill is on the Statute Book, the scheme will spring into life and begin to operate. Indeed, no. When the right hon. and learned Gentleman asks me about the future of doctors, I do not regard myself as being called upon to subject myself out of that courtesy which is natural to me—in these days at any rate—to a catechism on what is the Labour Party's policy.
We do not see the end of this scheme. It is only a party which lives in the past that can pretend it sees the end of any kind of scheme. Of course this is a developing policy, and we shall march on to greater and greater public service by the medical profession. What was published by my party in 1943, to which the right hon. and learned Gentleman referred, we of course stand by We have never repealed any of our policy, and we shall continue to march on in the light of that policy.
There are some really major issues involved. The speeches that have been made in this Debate by hon. Members opposite are an insult to the medical profession. What they say, in effect, is that, unless doctors are allowed to buy and sell practices like hucksters in the market place, and unless they can retain their private enterprise, they are not going to be good public servants. I deny that. In the public hospitals of this country today there are full-time salaried men who


never earn a guinea in fees. Is anybody going to suggest that they are bad doctors because there is not the motive of personal gain? I do not believe it, and I say that the younger doctors, who do not want to scramble and save money with which to buy practices and many of whom have served in the Forces, are public-spirited men who are prepared to serve the public without the incentive of being able to buy or sell practices or go running round with a good bedside manner to collect more and more patients. I do not believe what hon. Members have suggested of the medical profession.
As regards hospitals, the voluntary hospitals in this country played a very great part in the development of the hospital service when the central and local government authorities were unfamiliar with it and careless of the responsibility which they ought to have undertaken. The truth about the voluntary hospitals is that, under our social security scheme, they will not need to have flag days every day to raise the resources necessary for their conduct, or their administration, or for what is becoming more and more expensive, their equipment. It is inevitable now, and we should recognise, though with great thanks and deep regard for what they have done, that the life of the voluntary hospital system of this country is drawing to its close. The right hon. and learned Gentleman complained about regulations. He asked whether we had had the scheme worked out. I have told him that this is a living programme; we shall go on working it out and we shall go on improving on it. This is not finality. I is perfectly obvious that, with a complex scheme of this kind, wide powers of regulation must be given to the Minister. I know that the Opposition do not like it, but they will have to take a lot they do not like in this Parliament. Other times, other manners; other Governments, other men. Of course, we take our own point of view about that. It is impossible, in a Bill of this kind, to cover every conceivable contingency which may arise in respect to every hospital in the country. All of them exist under different conditions. It will be my right hon Friend's duty, in collaboration with all concerned, to make regulations which will fit the circumstances of our hospital system or the terms of employment of medical men. and so on.

We have had the criticism that this Bill is not positive enough. My hon. Friend the Member for Heywood and Radcliffe (Mr. A. W. J. Greenwood), whose maiden speech I listened to with great interest the other evening, made that point, and other hon. Members have made it too. This is a constructive and positive scheme, and a complete public health policy cannot be put in any single Measure. Our public health policy has grown up bit by bit in the most curious and haphazard way. People do not regard the question of sewerage, water supplies and drains as part of a public health service but in fact, it is. All that we are doing in this Bill fits into our policy for dealing with the environmental aspects of public health, together with research—to which reference has been made—and every other aspect of it, quite apart from treatment. We have gone a long way in the last 100 years. One hundred years ago London was virtually an undrained cesspool. I am sorry to say that in the presence of the Lord President of the Council, although, of course, he was not here at the time and I am not accusing him of any responsibility for it. The Thames, which flows just outside this Chamber, was a foul and stinking river, and often enough it was so foul that hon. Members could not sit in a Standing Committee room on the side of the House facing the river. We have marched on since then and this complex health system, to which all parties in this House have made their contribution—I freely admit that—has arrived at a stage when we have to take a big step forward, a step which, unfortunately, in my view, has been too long delayed. We are embarking on it now with considerable hope of success.
Let me deal with some of the points which were raised. I take, first, the question of the maldistribution of general practitioners. I do not know what the right hon. and learned Gentleman's method of dealing with the matter would be, but it is clear that, if one cares for the health of the people, one must see that doctors are fairly well distributed round the country. If there is to be a little direction, and if it is a public-spirited service, which I believe it to be, then, I think, that direction would be gladly accepted by the doctors. What is the position today? I have had a case given to me today. In the South Division of Bristol, which has one of the biggest single hous-


ing estates in the country and has a population of 34,000, there is not one resident medical man. Efforts to induce people to go have so far failed. In the town of Taunton, which is not far away and has a population of approximately 40,000, there are 56 registered medical practitioners. This is what freedom has meant. It has meant that in a growing housing estate there is no doctor, and in a small town—true, they may be serving more than 40,000 inhabitants; I do not wish to be unfair and overstate my case—there are 56 medical practitioners making a living somehow, no doubt out of these small farmers whose wealth we do not appreciate.

Mr. Prescott (Darwen): Is there any significance in the first example which the right hon. Gentleman quoted, of a local authority housing estate? Is it possible that there is no provision for a doctor to go there?

Mr. Greenwood: Until now there was no authority to order a doctor to go there.

Mr. Willink: I think I heard the right hon. Gentleman say, "Until now there was no authority to order a doctor to go." Are we to understand that under this Bill there will be authority to order a doctor to go?

Mr. Greenwood: If I remember the exact words I used, I think I said, "If to ensure the proper distribution of doctors there is to be some direction"—and it may very well be the case if we are going to have housing estates without doctors—"in my view, the medical profession will accept it."

Mr. Henry Strauss (Combined English Universities): I would like to put this question to the right hon. Gentleman. He said there is no power under existing Statutes. Is it not a fact that there has been power since 1911 for the Minister to make any arrangements he likes for the provision of a doctor, in any area where the Minister is not satisfied that there is proper medical provision?

Mr. Greenwood: I am prepared to follow that point, but I doubt whether the hon. and learned Gentleman is right in his statement of fact. I am certain that such powers as do exist are not adequate to deal with the problem.
My hon. Friend the Member for Ipswich (Mr. Stokes) raised the question of

Catholic hospitals. Where a hospital, transferred under the Bill, has any particular denominational background or associations that link it with some particular religious organisation, it is my right hon. Friend's intention to preserve the character of that institution. My right hon. Friend informs me that this can be done not only by prescribing the relevant features of the hospital, including staffing and general administration, but also in the selection of the personnel of the local management committee which will be concerned with the hospital in the future. It is really part of my right hon. Friend's intention that the peculiar character and personality of hospitals should, so far as possible, be respected and preserved, and I am sure my hon. Friend will be satisfied with that statement.
Then the question of opticians was raised. The intention is to give them their full and proper place in the new service, first in the interim supplementary eye service on the lines on which they have taken part in the national health service in the past, and secondly in the much more elaborate and effective ophthalmic clinic service which we intend to develop as part of our hospital and specialist services. I can assure hon. Members that the Minister is only too anxious to cooperate with the opticians in the working out of the scheme.
Some references have been made to the conditions of service, remuneration and so on. As hon. Members will be aware, the Bill gives the Minister a general power to prescribe by regulations the conditions of service, remuneration and qualifications of officers and servants employed by the new regional hospital boards or other bodies providing health services under the Bill. It is my right hon. Friend's intention, before prescribing any terms of service or rates of remuneration, to use the familiar machinery of discussion and negotiation with employees. Where suitable machinery exists and is in operation, it will be used with such adaptations as may be necessary in the new circumstances. What my right hon. Friend has in mind, where there is no machinery, is to set up some machinery of the Whitley Council type behind which there may be provision for agreed reference to arbitration should the Whitley Council not be able to carry it out. I think that principle will run all through my right hon.


Friend's administration of this great new service.
One or two speakers have raised the question of the domestic nursing service and the Queen's Institute. It was raised by the Noble Lady the Member for Hemel Hempstead (Viscountess Davidson), the hon. Member for Abingdon (Sir R. Glyn) and again today by the hon. and gallant Member for Chelmsford (Wing-Commander Millington). There are two points. One is the participation of the district nursing associations in the provision of home nursing services, and the other is the position of the Queen's Institute in relation to the training and supervision of nurses. On the first point. Clause 25 of the Bill provides for the possibility of voluntary nursing associations being used in the provision of home nursing services, and the procedure for preparing, working out and submitting proposals to the Minister, laid down in Clause 20, ensures that every voluntary organisation will know what the local health authority in the area is proposing to do, and gives it a statutory right to make recommendations to the Minister for modifying the proposals if it wishes to do so. This is the machinery which was adopted in an Act that has been on the Statute Book for 10 years—the Midwives Act, 1936—under which very extensive use has been made with very considerable success of the district nursing associations. My right hon. Friend intends to pursue that policy. On the question of the training and supervision of nurses, my right hon. Friend is fully aware of the importance of the problem, and proposes to discuss the whole issue with them as a separate problem at the earliest opportunity. I hope that will satisfy those Members who are interested in that issue.
I have dealt with Amendments for nearly a quarter of a century and I have never seen one quite as bad as that which we are now discussing. I am sorry to say the Tory hand has lost its cunning; perhaps it might get some from some other sources. The right hon. and learned Gentleman who moved this rather curious Amendment, who was the Minister of Health in the last Government, may remember that he and I crossed swords on issues arising out of the White Paper. There was an agreed White Paper and

then, somehow, in some mysterious way—and I am bound to say, some hole in the corner way—there were other discussions going on with official representatives of various organisations who were interested in the White Paper. I did not think that that was quite cricket myself, and I said so from the Box opposite just over a year ago. Anyhow, something leaked, and I had a copy of the document in my hand when I was speaking in the House on that occasion. I did not go looking for it; it just fell into my hands. The right hon. Gentleman was full of indignation. He said this was all quite unofficial; the Government were not committed to it at all. Then yesterday he made his speech on these new proposals, which he himself had offered to these various organisations if they would accept them. He had said, "I will father them on the National Government"

Mr. Willink: I know the right hon. Gentleman has said this before, and it is entirely inaccurate. I cannot give the details of it now, but it is entirely untrue that I ever said I would father any of these proposals whatever.

Hon. Members: Withdraw.

Mr. Greenwood: I am not going to withdraw. I understand that the right hon. and learned Gentleman undertook, if his advised proposals were accepted by these various organisations, to recommend their adoption to his colleagues in the War Cabinet.

Mr. Willink: That also 1 deny. It the right hon. Gentleman is going to say this I hope he will quote from some document which even purports to express my own words.

Mr. Greenwood: That is my information. [HON. MEMBERS: "Quote."] Unless I get disproval I certainly do not intend—

Sir W. Wakefield: Is it in Order, Mr. Speaker, for the right hon. Gentleman to make a statement about another right hon. Gentleman in the House and then, when the statement is denied, to persist in it and refuse to withdraw it?

Mr. Speaker: The right hon. Gentleman is entitled to make his case in his own way. His statement can be challenged, but that does not necessarily mean that it has to be withdrawn.

Sir W. Wakefield: Must not some evidence be produced, when it has been denied, to show that it is true?

Mr. Speaker: Evidence might also be produced from the other side.

Mr. Greenwood: I am sorry that I disposed of the printed document. I have no doubt I can recover a copy. My memory very rarely plays me false. I do not want to get at cross purposes with the right hon. and learned Gentleman, but I am quite certain that what he was talking about yesterday was not the White Paper; it was these proposals in the background, with which he was concerned. The argument in this Debate has not been between the White Paper and the proposals of my right hon. Friend—

Mr. Willink: I do not want to interrupt the right hon. Gentleman. [HON. MEMBERS: "Then why do so?"] The right hon. Gentleman has now been good enough to refer to a document. I am pretty sure I know to what document he is referring—the one he has not now with him. Will he make it clear to the House that that was not a document issued by the Ministry of Health, but a document issued by the British Medical Association?

Mr. Greenwood: I have now had a copy of the document handed to me. I am sorry to have had this little trouble. Hon. Members opposite are becoming a little touchy in their old age. The first paragraph of this document—[HON. MEMBERS: "What is it?"] Hon. Members opposite will not flurry me in that kind of way. I am going to give the whole of the facts. The British Medical Association had a special representative meeting, and this is a report by the Council on the negotiations with the Minister of Health. We had better have this read out: 
The Council has now received a report from the negotiating committee on the discussions which have been taking place with the Minister of Health and the Secretary of State for Scotland during the past few months. Included in its report is an administrative structure put forward by the Minister as a possible alternative to that outlined in the White Paper.
[Interruption.] I have not finished yet.
These alternative proposals are not now proposals put forward by the Government in place of the White Paper.
[HON. MEMBERS: "Hear, hear."] Wait a minute.

They are proposals which the Minister will be willing to put to his colleagues as soon as he knows whether they commend themselves to the medical profession or not.
[HON. MEMBERS: "Withdraw."] I think if there is anything to be withdrawn it ought to be withdrawn from the other side. However, I do not press the matter; I have made my point. When the Bill goes to Standing Committee my right hon. Friend will not be unreasonable. He will be prepared to listen to arguments and will not close his mind to any improvement that can be made on the Committee stage. At the same time, I am bound to say that in spite of the studied moderation of his speech on Second Reading—which I think illuminated the House of Commons—I believe he is determined to get this Bill through. We certainly shall get it through, and no amount of misrepresentation will deter us. A short time ago I had two leaflets given to me neither of which bears any printer's or publisher's imprint. It is vicious propaganda which has emanated, I am sorry to say, from the medical profession. [HON. MEMBERS: "A section."] From a section of the medical profession, certainly. They say:
You want the best medical advice and medical services, so do the doctors. They want to help you to make sure you really get them. You want to change your own doctor and to change to another if you feel like it. But "—
in large print—
after the National Health Service becomes law your choice will be restricted.
[HON. MEMBERS: "Hear, hear."] What about South Bristol? Is their choice to be extended? This talk about the choice of doctor has always been an illusion, except for the rich. The ordinary rank and file of our people have to pick their doctors from the districts in which they live. It goes on getting worse. I have no time to read it all, but I commend it to my hon. Friends:
If you want to feel that your doctor is your own doctor, the National Health Service Bill will turn your doctor into the State's doctor. 
We have heard that already.
He will become a salaried doctor.
I have more or less dealt with that. This paper is an attempt to prejudice this Bill before it has had a chance to operate. They are trying to make out that there is something very holy in the


relationship between doctor and patient. It may be a strong personal relationship, but I say that I know doctors in public hospitals who are just as sympathetic towards the hospital inmates and patients as any private enterprise doctor would be. Then it goes on:
You want your doctor's certificates to be given on his own judgment of your case.
Then, in large print:
Under the National Health Service Bill he will be the State doctor and the State
—mark this, it is a most offensive statement—
and the State may want to control the doctor's certificates in order to save the social security funds.
What is this monstrous suggestion? It is that my right hon. Friend is prepared to monkey about with doctors' certificates in order to save the contributions of the Treasury. I say it is an insult. There is another one which is even sweeter in a way:
Will it make you healthier?
—there is no argument about this, because doctors know best—
Will Mr. Bevan's Bill improve your health by giving you a better house or better food?
This time the answer is in very small print:
It will not.
There really is not much argument, and if this campaign is to be conducted on that kind of basis, I am very sorry for the morals of our public life. I am not so sure that these two documents are not illegal. They bear no publisher's or printer's name—I shall cherish these two leaflets until the Bill is on the Statute Book, and the donor of them will not get them back. That is the kind of campaign we are putting up with.

Division No. 136.]
AYES
6.37 p.m.


Adams, W. T (Hammersmith, South)
Battley, J R.
Bowles, F. G. (Nuneaton)


Adamson, Mrs. J. L.
Bechervaise, A. E
Braddock, Mrs. E. M. (L'p'I, Exch'ge)


Allen A. C (Bosworth)
Belcher, J. W.
Braddock, T. (Mitcham)


Allen, Scholefield (Crewe)
Bellenger, F. J.
Brook, D. (Halifax)


Allighan, Garry
Benson, G.
Brooks, T. J. (Rothwell)


Alpass, J. H
Berry, H
Brown, George (Belper)


Anderson, A (Motherwell)
Beswick, Fit.-Lieut. F.
Brown, T. J. (Ince)


Anderson, F. (Whitehaven)
Bevan, Rt. Hon. A. (Ebbw Vale)
Brown, W. J. (Rugby)


Attewell, H. C.
Bing, Capt. G. H. C
Bruce, Maj. D. W. T


Attlee, Rt. Hon. C. R.
Binns, J.
Burden, T. W.



Awbery, S. S.
Blackburn, A. R.
Burke, W. A.


Ayrton Gould, Mrs. B
Blenkinsop, Capt. A
Butler, H. W. (Hackney, S.)


Baird, Capt. J.
Blyton, W. R.
Byers, Lt.-Col. F.


Balfour, A.
Boardman, H.
Callaghan, James


Barnes, Rt. Hon. A. J
Bottomley, A. G.
Castle, Mrs. B. A


Barstow, P. G.
Bowden, Flg.-Offr. H W
Champion, A. J


Barton, C
Bowen, R.
Chater, D

We are concerned not about the medical profession, or the dentists, or the opticians; we are concerned about the health of the people of this country. With what else should we be concerned? The vast majority of my hon. Friends on this side of the House come from humble homes; we know what the life of the working classes is, we want their health improved. Of course we do. We want them to have at their disposal the best possible treatment in the best possible circumstances, and we regard all these agencies whether they are institutions or persons, as instruments for carrying out this great improvement in the health of our people. We are wasting not merely money, we are wasting human life and human energy because there is an enormous amount of preventable disease in this country which is not being prevented. There is a reference to research. One of the things which is very close to the mind of my right hon. Friend is research into that most gruelling complaint—I speak as a sufferer—rheumatism. My right hon. Friend will do all he can in that direction, because he wants to avoid unnecessary human suffering.
There is, however, a wider motive behind my right hon. Friend and the Government, and that is to improve the temple of the human spirit—to improve the quality of the human body, so that a great people, as we have proved ourselves to be, may through a new environment and better treatment become more worthy citizens of this great country. If the Opposition choose to divide against us, they are quite welcome to do so.
Question put, "That the words proposed to be left out stand part of the Question."


Chetwynd, Capt. G. R.
Hastings, Dr. Somerville
Mulvey, A.


Clitherow, Dr. R.

Haworth, J.
Murray, J. D


Cluse, W. S.
Henderson, A. (Kingswinford)
Nally, W.


Cobb, F. A.
Herbison, Miss M.
Naylor, T. E.


Cocks, F. S.
Hewitson Capt. M.
Neal, H. (Claycross)


Coldrick, W.
Hicks, G
Nichol, Mrs. M. E. (Bradford, N.)


Collindridge, F.
Hobson, C. R.
Nicholls, H. R. (Stratford)


Collins, V. J.
Holman, P.
Noel-Buxton, Lady


Colman, Miss G. M
Holmes, H. E (Hemsworth)
O'Brien, T.


Comyns, Dr. L.
Horabin, T. L.
Oldfield, W. H.


Cook, T. F.
House, G.
Oliver, G. H.


Cooper, Wing-Comdr. G.
Hoy, J.
Orbach, M.


Corbet, Mrs. F. K. (Camb'well, N.W.)
Hubbard, T.
Paget, R. T.


Corlett, Dr. J.
Hughes, Emrys (S. Ayr)
Paling, Rt. Hon. Wilfred (Wentworth)


Corvedale, Viscount
Hughes, Lt. H. D. (W'Iverh'pton, W.)
Paling, Will T. (Dewsbury)


Cove, W. G.
Hutchinson, H. L. (Rusholme)
Palmer, A. M. F


Crawley, Flt.-Lieut. A
Hynd, H. (Hackney, C.)
Pargiter, G. A


Cunningham, P
Irving, W. J.
Parker, J.


Daggar, G.
Isaacs, Rt. Hon. G. A.
Parkin, Flt.-Lieut. B. T.


Daines, P.
Janner, B.
Paton, Mrs. F. (Rushcliffe)


Dalton, Rt. Hon. H.
Jeger, Capt. G. (Winchester)
Paton, J. (Norwich)


Davies, Edward (Burslem)
Jeger, Dr. S. W. (St. Pancras, S.E.)
Pearson, A.


Davies, Clement (Montgomery)
Jones, A. C. (Shipley)
Pearl, Capt. T. F


Davies, Ernest (Enfield)
Jones, J. H. (Bolton)
Perrins, W.


Davies. Harold (Leek)
Jones, P. Asterley, (Hitchin)
Piratin, P.


Davies, Haydn (St. Pancras, S.W.)
Keenan, W.
Platts-Mills, J. F. F.


Davies, R J. (Westhoughton)
Kenyon, C.
Poole, Maj. Cecil (Lichfield)


Deer G.
Key, C. W.
Popplewell, E.


de Freitas, Geoffrey
King, E. M.
Porter, E. (Warrington)


Delargy, Captain H. J.
Kinghorn, Sqn. Ldr. E.
Porter, G. (Leeds)


Diamond, J.
Kinley, J.
Price M. P.


Dobbie, W.
Kirby, B. V.
Pritt, D. N.


Donovan, T.
Kirkwood, D
Proctor, W. T


Douglas, F. C. R.
Lang, G.
Pursey, Cmdr. H


Driberg, T. E. N.
Lavers, S.
Ranger, J.


Dumpleton, C. W.
Lee, F. (Hulme)
Rankin, J.


Durbin, E. F. M.
Lee, Miss J. (Cannock)
Reeves, J.


Dye, S.
Leonard, W.
Reid, T. (Swindon)


Ede, Rt. Hon. J. C.
Leslie, J. R.
Rhodes, H.


Edwards, A. (Middlesbrough, E.)
Lever, Fl. Off. N. H.
Richards, R.


Edwards, Rt. Hon. Sir C. (Bedwellty)
Levy, B. W.
Ridealgh, Mrs. M.


Edward, N (Caerphilly)
Lewis, A. W. J. (Upton)
Robens, A.


Edwards, W. J. (Whitechapel)
Lewis, T. (Southampton)
Roberts, Sqn.-Ldr. Emrys (Merioneth)


Evans. E. (Lowestoft)
Lindgren, G. S.
Roberts, Goronwy (Caernarvonshire)


Ewart, R.
Lindsay, K. M. (Comb'd Eng. Univ.)
Roberts, W. (Cumberland, N.)


Fairhurst, F.
Lipson, D. L.
Robertson, J. J. (Berwick)


Farthing, W. J.
Lipton, Lt.-Col. M
Rogers, G. H. R.


Fletcher, E. G. M. (Islington, E.)
Longden, F.
Royle, C


Follick, M.
Lyne, A. W.
Sargood, R.


Foot, M. M.
McAdam, W.
ScoIlan, T.


Foster, W. (Wigan)
McAllister, G.
Scott-Elliot, W.


Fraser, T. (Hamilton)
McEntee, V. La T
Segal, Sq.-Ldr. S.


Freeman, Maj. J. (Watford)
McGhee, H. G.
Shackleton, Wing-Cdr. E. A. A.


Freeman, Peter (Newport)
McKay, J. (Wallsend)
Sharp, Lt.-Col. G. M.


Gaitskell, H. T. N.
Mackay, R. W. G. (Hull, N.W.)
Shawcross, Sir H. (St. Helens)


Ganley, Mrs. C. S.
McKinlay, A. S.
Shinwell, Rt. Hon. E.


George, Maj. Rt. Hn. C. Lloyd (P'ke)
Maclean, N (Govan)
Shurmer, P.


George, Lady M. Lloyd (Anglesey)
McLeavy, F
Silkin, Rt. Hon. L.


Gibbins, J.
MacMillan, M K
Silverman J (Erdington)


Gibson, C. W.
McNeil, H.
Silverman, S. S. (Nelson)


Gilzean, A.
Macpherson, T. (Romford)
Simmons C. J.


Glanville. J. E. (Consett)
Mainwaring, W. H.
Skeffington, A. M.


Gooch, E. G.
Mallalieu, J. P. W.
Skeffington-Lodge, T. C


Goodrich, H. E.
Mann, Mrs. J.
Skinnard, F. W.


Gordon-Walker, P. C.

Manning, C. (Camberwell, N.)
Smith, Capt. C. (Colchester)


Granville, E. (Eye)
Manning, Mrs. L. (Epping)
Smith. H. N. (Nottingham, W.)


Greenwood, Rt. Hon. A. (Wakefield)
Marshall, F. (Brightside)
Smith, S H. (Hull, S.W.)


Greenwood, A. W. J. (Heywood)
Martin, J. H.
Smith, T (Normanton)


Granfell, D. R.
Mothers, G.
Snow, Capt. J. W.


Grey, C. F.
Mayhew, C. P.
Sorensen, R. W.


Griersen, E.
Medland, H M.
Soskice, Maj. Sir F


Griffiths, D. (Rother Valley)
Messer, F.
Sparks, J. A.


Griffiths, Rt. Hon. J. (Llanslly)
Middleton, Mrs. L.
Stamford, W


Griffiths, Capt. W. D. (Moss Side)
Mikardo, Ian
Steele, T


Guest, Dr. L. Haden
Millington, Wing-Comdr. E. R.
Stephen, C.


Gunter, Capt. R. J.
Mitchison, Maj. G. R.
Stokes, R. R.


Guy, W. H.
Monslow, W.
Strachey, J.


Hale, Leslie
Montague, F.
Strauss, G. R


Hall, Rt. Hon. G. H. (Aberdare)
Moody, A. S.
Stross, Dr B.


Hall, W. G. (Colne Valley)
Morgan, Dr. H. B.
Stubbs, A. E.


Hamilton, Lieut.-Col. R.
Morley, R.
Summerskill, Dr. Edith


Hannan, W. (Maryhill)
Morris, P. (Swansea, W.)
Swingler, Capt. S.


Hardman, D. R.
Morris, H. (Carmarthen)
Symonds, Maj. A. L.


Hardy, E. A.
Morrison, Rt. Hon. H. (Lewisham, E.)
Taylor, H. B. (Mansfield)


Harris, H. Wilson

Mort, D. L.
Taylor, R. J (Morpeth)


Harrison, J.
Moyle, A.
Taylor, Dr. S. (Barnet)







Thomas, Ivor (Keighley)
Wallace, G. D. (Chislehurst)
Williams, J. L. (Kelvingrove)


Thomas, I. O. (Wrekin)
Wallace, H. W. (Walthamstow, E.)
Williams, Rt. Hon. T. (Don Valley)


Thomas, John R. (Dover)
Warbey, W. N.
Williams, W. R. (Heston)


Thomas, George (Cardiff)
Watkins, T. E.
Williamson, T.


Thomson, Rt. Hn. G. R. (Ed'b'gh, E.)
Watson, W. M.
Willis, E.


Thorneycroft, H.
Weitzman, D.
Wills, Mrs E. A.


Thurtle, E.
Wells, P. L. (Faversham)
Wilmot, Rt. Hon. J


Timmons, J.
Wells, W. T. (Walsall)
Wilson, J. H.


Titterington, M. F.
Westwood, Rt. Hon. J.
Wise, Major F. J.


Tolley, L.
White, C. F. (Derbyshire, W.)
Woodburn, A.


Tomlinson, Rt. Hon. G.
White, H. (Derbyshire, N.E.)
Yates, V. F.


Turner-Samuels, M.
Whiteley, Rt. Hon. W.
Young, Sir R. (Newton)


Ungoed-Thomas, L.
Wigg, Col. G. E.
Younger, Hon. K. G.


Usborne, Henry
Wilcock, Group-Capt. C. A. B.
Zilliacus, K.


Vernon, Maj. W. F.
Wilkes, Maj. L.



Viant, S. P.
Wilkins, W. A.
TELLERS FOR THE AYES


Walkden, E.
Willey, O. G. (Cleveland)
Mr. Joseph Henderson and


Walker, G. H.
Williams, D. J. (Neath)
Captain Michael Stewart




NOES.


Agnew. Cmdr. P G.
Hinchingbrooke, Viscount
Pitman, I. J.


Aitken, Hon Max
Hollis, Sqn.-Ldr. M. C.
Prescott, Stanley


Allen, Lt.-Col. Sir W. (Armagh)
Holmes, Sir J. Stanley
Price-White, Lt.-Col. D.


Anderson, Rt. Hn. Sir J. (Scot. Univ.)
Hope, Lord J.
Prior-Palmer, Brig. O


Assheton, Rt. Hon. R
Howard, Hon. A.
Raikes, H. V.


Baldwin, A. E.
Hudson, Rt. Hon. R S. (Southport)
Ramsay, Maj. S


Barlow, Sir J.
Hulbert, Wing-Comdr. N. J.
Rayner, Brig. R.


Baxter, A. B.
Hurd, A.
Reed, Sir S. (Aylesbury)


Beamish, Maj. T. V. H
Hutchison, Lt.-Cm. Clark (E'b'rgh W.)
Reid, Rt. Hon. J. S. C. (Hillhead)


Beechman, N. A.
Hutchison, Col. J. R. (Glasgow, C.)
Renton, D.


Bennett, Sir P.
Jarvis, Sir J.
Roberts, H. (Handsworth)


Birch, Lt.-Col. Nigel
Jeffreys, General Sir G.
Roberts, Maj. P. G. (Ecclesall)


Bossom, A. C
Jennings R.
Robertson, Sir D. (Streatham)


Boyd-Carpenter, J A.
Keeling, E. H.
Ropner, Col. L.


Bromley-Davenport. Lt.-Co W
Kerr, Sir J. Graham
Ross, Sir R.


Bullock, Capt. M.
Kingsmill, Lt.-Col. W. H.
Sanderson, Sir F.


Butcher, H. W.
Lambert, Hon. G.
Savory, Prof. D. L.


Butler, Rt Hon R. A (S'ffr'n W'ld'n)
Law, Rt. Hon. R. K.
Scott, Lord W.


Carson, E.
Legge-Bourke, Maj E. A. H
Shepherd, Lieut. W. S. (Bucklew)


Challen, Flt.-Lieut. C
Lennox-Boyd, A. T
Smiles, Lt.-Col. Sir W.


Channon, H.
Lloyd, Maj. Guy (Renfrew. E.)
Smithers, Sir W


Churchill, Rt. Hon. W. S.
Low, Brig. A. R W.
Snadden, W M.


Clarke, Col. R. S.
Lucas, Major Sir J
Spearman, A. C. M


Clifton Brown, Lt.-Col. G
Lucas-Tooth, Sir H
Spence, Maj. H. R.


Cole, T. L.
Lyttelton, Rt. Hon. O
Stanley, Rt. Hon. O.


Conant, Maj. R. J. E.
MacAndrew, Col. Sir C.
Stewart, J. Henderson (Fife, E.)


Cooper-Key, E. M.
McCallum, Maj. D.
Steddart-Scott, Col. M.


Corbett., Lieut.-Col. U. (Ludlow)
MacDonald, Sir M. (Inverness)
Strauss, H. G. (Corn. Eng. Univ'sities)



Crookshank, Capt. Rt. Hon. H. F. C.
Macdonald, Capt. Sir P. (I. of Wight)
Studholme, H. G


Crowder, Capt. J. F. E.
Mackeson, Lt.-Col. H. R.
Sutcliffe, H.


Cuthbert, W. N.
McKie, J. H. (Galloway)
Taylor, C. S. (Eastbourne)


Darling, Sir W. Y.
Maclay, Hon. J. S.
Taylor, Vice-Adm. E. A. (P'dd'ton, S.)


Davidson, Viscountess
Maclean, Brig. F. H. R. (Lancaster)
Teeling, William


De la Bere, R.
MacLeod, Capt. J.
Thomas, J. P. L. (Hereford)


Digby, Maj S. W.
Macmillan, Rt. Hon. Harold
Thomson Sir D. (Aberdeen, S.)


Donner, Sqn.-Ldr. P W
Macpherson, Maj. N. (Dumfries)
Thornton-Kemsley, C. N.


Drewe, C
Maitland, Camdr. J. W.
Thorp, Lt.-Col. R. A. F.


Dugdale, Maj. Sir T (Richmond)
Manningham-Buller, R. E.
Touche, G. C.


Duthie, W. S
Marlowe, A. A. H.
Turton, R. H.


Eccles, D. M.
Marples, A. E.
Wakefield, Sir W. W


Eden, Rt. Hon. A.
Marsden, Capt. A.
Walker-Smith, D


Erroll, F. J.
Marshall, D. (Bodmin)
Ward, Hon. G. R


Fleming, Sqn.-Ldr E. L
Marshall, S. H. (Suton)
Watt, Sir G. S. Harvie


Fletcher, W. (Bury)
Maude, J. C.
Webbe, Sir H. (Abbey)


Foster, J. G. (Northwich)
Medlicott, Brig. F
Wheatley, Colonel M J.


Fraser, Maj. H. C. P. (Stone)
Mellor, Sir J.

White, Sir D. (Fareham)


Fraser, Lt.-Col. Sir I. (Lonsdale)
Moore, Lt.-Col. Sir T.
White, J. B (Canterbury)


Galbraith Cmdr. T. D.
Morris-Jones, Sir H.
Williams, C. (Torquay)


Glossop. C. W. H.
Morrison, Maj J. G. (Salisbury)
Williams, Gerald (Tonbridge)


Gomme-Duncan, Col. A. G
Neill, W. F. (Belfast, N.)
Willink, Rt. Hon H. U.


Graham-Little Sir E
Neven-Spence, Major Sir B
Willoughby, de Eresby, Lord


Gridley. Sir A
Nicholsor G.
Winterton, Rt Hon Earl


Grimston, R. V.
Noble, Comdr A. H. P.
York, C.


Hannon, Sir P. (Moseley)
O'Neill, Rt Hon Sir H
Young, Sir A. S L. (Partick)


Harvey, Air-Comdre. A. V
Orr-Ewing, I. L.



Haughton, S G.
Osborne, C.
TELLERS FOR THE NOES


Head, Brig. A. H.
Peake. Rt. Hon. O.
Mr. James Stuart and


Headlam. Lieut.-Col. Rt Hon Sir C
Peto, Brig. C H. M
Mr. Buchan-Hepburn.


Henderson, John (Cathcart)
Picktborn K



Bill read a Second time.

The House divided: Ayes, 359; Noes, 172.

Mr. Churchill (Woodford): I beg to move, "That the Bill be committed to a Committee of the Whole House."

NOES.


Adams, W. T. (Hammersmith, South)
Baird, Capt. J.

Bevan, Rt. Hon. A. (Ebbw Vale)


Adamson, Mrs. J. L.
Balfour, A.
Bevin, Rt Hon. E. (Wandsworth, C.)


Allen, A. C. (Bosworth)
Barnes, Rt. Hon. A. J
Blackburn. A. R.


Allen, Scholefield (Crewe)
Barstow, P. G.
Blenkinsop, Capt. A


Allighan, Garry
Barton, C.
Blyton, W. R.


Alpass, J. H.
Battley, J. R.
Boardman, H.


Anderson, A. (Motherwell)
Bechervaise, A. E.
Bottomley, A. G.


Anderson, F. (Whitehaven)
Belcher, J. W.
Bowden Flg.-Offr. H. W


Attewell, H. C.
Bellenger, F. J
Bowles, F G. (Nuneaton)


Attlee, Rt. Hon. C. R
Benson, G.
Braddock Mrs. E M. (L'pI, Exch'ge)


Awbery, S. S.
Berry, H.
Braddock, T. (Mitcham)


Ayrton Gould, Mrs. B
Beswick, Flt.-Lieut. F
Brook. D. (Halifax)

Question put.

The House divided: Ayes, 180; Noes, 344.

Brooks, T. J. (Rothwell)
Hardy, E. A
Murray, J. D


Brown, George (Belper)
Harrison, J.
Nally, W.


Brown, T J. (Ince)
Hastings, Dr. Somerville
Naylor, T. E.


Brown, W. J. (Rugby)
Haworth, J.
Neal, H. (Claycross)


Bruce, Maj. D. W. T
Henderson, A. (Kingswinford)
Nichol, Mrs. M. E. (Bradford, N.)


Burden, T. W.
Herbison, Miss M.
Nicholls, H. R. (Stratford)


Burke, W. A.
Hewitson, Capt. M
Noel-Baker, Rt. Hon. P. J (Derby)


Butler, H. W. (Hackney, S.)
Hicks, G.
Noel-Buxton, Lady


Callaghan, James
Hobson, C. R.
O'Brien, T.


Castle, Mrs. B. A.
Holman, P.
Oldfield, W. H.


Champion, A. J.
Holmes, H. E. (Hemsworth)
Oliver, G. H.


Chater, D.
Horabin, T. L.
Orbach, M.



Chetwynd, Capt. G. R.
House, G.
Paget, R. T.


Clitherow, Dr. R.
Hoy, J.
Paling, Rt. Hon. Wilfred (Wentworth)



Cobb, F. A.
Hubbard, T
Paling, Will T. (Dewsbury)


Cocks, F. S.
Hughes, Emrys (S. Ayr)
Palmer, A. M. F.


Coldrick, W.
Hughes, Lt. H. D. (W'Iverh'pton, W.)
Pargiter, G. A.


Collindridge, F.
Hutchinson, H. L (Rusholme)
Parker, J.


Collins, V. J.
Hynd, H (Hackney, C.)
Parkin, Fit.-Lieut. B. T.


Colman, Miss G M
Irving, W. J.
Paton, Mrs. F. (Rushcliffe)


Comyns, Dr. L
Isaacs, Rt Hon. G. A.
Paton, J. (Norwich)


Cook, T. F.
Janner, B.
Pearson, A.


Cooper, Wing.Comdr. G
Jeger, G. (Winchester)
Pearl, Capt. T F


Corbet, Mrs. F. K (Camb'well, N.W.)
Jeger, Dr. S. W. (St. Pancras, S.E.)
Perrins, W.


Corlett, Dr. J.
Jones, A. C. (Shipley)
Piratin, P.


Corvedale, Viscount
Jones, J. H. (Bolton)
Platts-Mills, J. F. F.


Cove, W. G
Jones, P. Asterley (Hitchin)
Poole, Maj. Cecil (Lichfield)


Crawley, Fit -Lieut. A
Keenan, W.
Poppiewell, E.


Daggar, G.
Kenyon, C.
Porter, E (Warrington)


Daines, P.
Key, C. W.
Porter, G. (Leeds)


Dalton, Rt. Hon. H.
King, E. M.
Price, M P.


Davies, Edward (Burslem)
Kinghorn, Sqn.-Ldr. E
Pritt, D. N.


Davies, Ernest (Enfield)
Kinley, J.
Proctor, W. T.


Davies, Harold (Leek)
Kirby, B. V.
Pursey, Cmdr. H


Davies, Haydn (St. Pancras, S.W.)
Kirkwood, D
Ranger, J.


Davies, R J. (Westhoughton)
Lang, G.
Rankin, J,


Deer, G.
Lavers, S.
Reeves, J.


de Freitas, Geoffrey
Lee, F. (Hulme)
Reid, T. (Swindon)


Detargy, Captain H. J
Lee, Miss J. (Cannock)
Rhodes, H.


Diamond. J
Leonard, W.
Richards, R.


Dobbie, W.
Leslie, J. R.
Ridealgh, Mrs. M


Donovan, T
Lever, Fi. Off. N. H.
Robens, A.


Douglas, F. C. R
Levy, B. W.
Roberts, Goronwy (Caernarvonshire)


Driberg, T. E. N.
Lewis, A. W. J. (Upton)
Roberts, W. (Cumberland, N.)


Dumpleton, C. W.
Lewis, T (Southampton)
Robertson, J. J. (Berwick)


Durbin, E. F. M
Lindgren G. S.
Rogers, G. H R


Dye, S.
Lindsay, K. M (Comb'd Eng. Univ.)
Royle, C.


Ede, Rt. Hon. J. C.
Lipton, Lt.-Col M.
Sargood, R.


Edwards, A (Middlesbrough, E.)
Longden, F.
Scollan, T.


Edwards, Rt. Hon. Sir C. (Bedwelty)
Lyne, A. W.

Scott-Elliot, W


Edwards, N. (Caerphilly)
McAdam, W
Segal, Dr. S


Edwards, W. J. (Whitechapel)
McAllister, G.
Shackleton, Wing-Cdr. E A A


Evans, E. (Lowestoft)
McEntee, V. La T
Sharp, Lt.-Col G. M.


Ewart, R.
McGhee, H. G.
Shawcross, Sir H. (St. Helens)


Fairhurst, F.
McKay, J. (Wallsend)
Shinwell, Rt Hon. E


Farthing, W. J.
Mackay, R. W. G. (Hull, N.W.)
Shurmer, P


Fletcher, E. G. M (Islington, E.)
McKinlay, A. S.
Silkin, Rt. Hon L.


Follick, M.
Maclean, N. (Govan)
Silverman, J. (Erdington)


Foot, M. M.
McLeavy, F.
Silverman, S. S. (Neison)


Foster, W (Wigan)
MacMillan, M K. (Western Isles)
Simmons, C. J.


Fraser, T. (Hamilton)
McNeil, H.
Skeffington, A. M.


Freeman, Maj. J. (Watford)
Macpherson, T. (Romford)
Skeffington-Lodge, T. C


Freeman, Peter (Newport)
Mainwaring, W H.
Skinnard, F. W.


Gaitskell, H. T. N
Mallalieu, J. P. W
Smith, Capt C. (Colchester)


Gibbins, J.
Mann, Mrs. J.
Smith, H. N. (Nottingham, S.)


Gibson, C. W
Manning, C (Camberwell, N.)
Smith, S. H. (Hull, S.W.)


Gilzean, A.
Manning, Mrs. L. (Epping)
Smith, T. (Normanton)


Glanville. J. E (Consett)
Marshall, F. (Brightside)
Snow, Capt. J. W.


Gooch, E. G.
Martin, J. H.
Sorensen, R. W.


Goodrich, H. E
Mathers, G.
Soskice, Maj. Sir F


Gordon Walker P C
Mayhew C. P.
Sparks, J. A


Greenwood, Rt. Hon. A. (Wakefield)
Medland, H. M
Stamford. W


Greenwood, A. W. J. (Heywood)
Messer, F.
Steele, T.


Grenfell, D. R.
Middleton, Mrs. L
Stephen, C.


Grey, C. F.
Mikardo, Ian
Stokes, R. R.


Grierson, E.
Millington, Wing-Comdr E R
Strachey, J.


Griffiths, D. (Rother Valley)
Mitchison, Maj. G. R
Strauss, G. R. (Lambeth)


Griffiths, Rt. Hon. J. (Llarelly)
Monslow, W.
Stross, Dr. B


Griffiths, Capt. W. D. (Moss Side)
Montague, F.
Stubbs, A. E.


Guest, Dr. L. Haden
Moody, A. S.
Summerskill, Dr. Edith


Gunter, Capt. R. J
Morgan, Dr. H. B
Swingler, Capt. S.


Guy, W. H.
Morley, R.
Symonds, Maj. A. L.


Hale, Leslie
Morris, P (Swansea, W.)
Taylor, H. B. (Mansfield)


Hall, W G. (Colne Valley)
Morrison, Rt. Hon. H. (Lewisham, E.)
Taylor, R. J. (Morpeth)


Hamilton, Lieut.-Col. R
Mort, D. L
Taylor, Dr. S. (Barnet)


Hannan, W. (Maryhill)
Moyle, A
Thomas, Ivor (Keighley)


Hardman, D. R.
Moyle, A
Thomas, Ivor (Keighley)

Thomas, I. O. (Wrekin)
Wallace, H. W. (Walthamstow, E.)
Williams, Rt. Hon. T. (Don Valley)


Thomas, John R. (Dover)
Warbey, W. N.
Williams, W. R. (Heston)


Thomas, George (Cardiff)
Watkins, T. E.
Williamson, T.


Thomson, Rt. Hn. G. R. (Ed'b'gh, E.)
Watson, W. M.
Willis, E.


Thorneycroft, H. (Clayton)
Weitzman, D.
Wills, Mrs. E. A


Thurtle, E.
Wells, P. L. (Faversham)
Wilmot, Rt. Hon. J


Timmons, J.
Wells, W. T. (Walsall)
Wilson, J. H.


Titterington, M. F.
Westwood, Rt. Hon. J.
Wise, Major F. J


Tolley, L.
White, C. F. (Derbyshire, W.)
Woodburn, A


Tomlinson, Rt. Hon. G.
White, H. (Derbyshire, N.E.)
Yates, V. F.


Turner-Samuels, M.
Whiteley, Rt. Hon. W.
Young, Sir R. (Newton)


Ungoed-Thomas, L.
Wigg, Col. G. E.
Younger, Hon. Kenneth


Usborne, Henry
Wilcock, Group-Capt. C A. B
Zilliacus, K.


Vernon, Maj. W. F
Wilkes, Maj. L.



Viant, S. P.
Wilkins, W. A.
TELLERS FOR THE NOES


Walkden, E.
Willey, O. G. (Cleveland)
Mr. Joseph Henderson and


Walker, G. H.
Williams, D. J. (Heath)
Captain Michael Stewart.


Wallace. G. D. (Chislehurst)
Williams, J. L. (Kelvingrove)

NATIONAL HEALTH SERVICE [MONEY]

Considered in Committee under Standing Order No. 69

[Major MILNER in the Chair]

Motion made, and Question proposed,
That, for the purposes of any Act of the present Session, to provide for the establishment of a comprehensive health service in England and Wales and for purposes connected therewith, it is expedient to authorise the payment out of moneys provided by Parliament of—

expenses incurred by the Minister of Health in the exercise of his functions under the said Act, the Lunacy and Mental Treatment Acts, 1890 to 1930, or the Mental Deficiency Acts, 1913 to 1938;
compensation payable to medical practitioners in respect of losses suffered by reason of any provision of the said Act prohibiting the sale of medical practices, the aggregate amount of such compensation not exceeding the appropriate proportion determined in accordance with the said Act of sixty-six million pounds. and interest on that compensation;
grants payable to local health authorities in respect of expenditure incurred by them in carrying out their functions as such authorities or in defraying expenses of any joint board exercising such functions, being grants not exceeding, in the case of any authority, three quarters of the expenditure so incurred by that authority;
sums necessary to defray the expenditure of Regional Hospital Boards constituted under the said Act (including the expenditure of Hospital Management Committees so constituted in exercising functions on behalf of such Boards) and the expenditure of Boards of Governors so constituted for teaching hospitals;
expenses incurred by other bodies constituted under the said Act;
remuneration and travelling and subsistence allowances payable to members of bodies constituted under the said Act;

superannuation benefits provided for officers engaged in health services and medical practitioners and dental practitioners providing services under the said Act; and
the remuneration of an additional medical Commissioner of the Board of Control;

and to authorise the payment into the Exchequer of sums received by the Minister of Health under the said Act "—(King's Recommendation signified.)—[Mr. Bevan.]

7.5 p.m.

Mr. Richard Law (Kensington, South): The most remarkable thing about this Financial Resolution is that it covers a tremendously wide field, involving large sums of money, for a variety of purposes, and only once is any specific sum mentioned—that of £66 million. That is for a purpose which, as I hope to show the Committee, is not in itself necessary. In these days, when we consider the financial position of our country, I think that the Committee generally will agree that it is undesirable to spend great sums of money, unless the necessity of doing so can be proved absolutely. I hold that no necessity has been proved in this case. The £66 million is to be provided for compensation payable to medical practitioners in respect of losses suffered by reason of the Act. In other words, it is to be payable to medical practitioners to compensate them for the prohibition on the buying and selling of their practices. It seems to me—and nothing which I have heard in the previous Debate has altered my mind—that, whatever the arguments may be for or against the buying and selling of practices, it has not been demonstrated that the prohibition on the buying and selling of practices is necessary for any of the fundamental purposes of the right hon. Gentleman, so far as this Bill is concerned. The argument, as I understand it, is that the prohibition on the selling and buying of practices is neces-


in order to ensure an even and fair distribution of doctors throughout the country.

Mr. Sydney Silverman (Nelson and Colne): On a point of Order. I gather that the right hon. Gentleman is proceeding to a discussion on the merits or demerits of the prohibition on the buying and selling of practices. I do not see anything in the Money Resolution about that. I would ask how far it is in Order on this Resolution to discuss whether the prohibition is wise or unwise. Is not the only question, whether or not the money should be provided for compensation?

The Chairman: The object of the Money Resolution is to provide finance for the items set out in the Motion. If the right hon. Gentleman goes outside that rather wide area, he will, of course, be out of Order.

Earl Winterton (Horsham): Is it not in Order, Major Milner, on a Resolution of this kind, to discuss the merits of the case? Otherwise the Resolution would be perfectly useless. If the principle of the point of Order raised by the hon. Gentleman is to be accepted, why have this Resolution at all? How can we discuss the sum of money involved, without discussing the merits of the case?

Mr. Silverman: I do not invite you to rule, Major Milner, that there would be anything improper in saying either that compensation ought to be paid, or that compensation ought not to be paid. I invite you to rule that any discussion on the prohibition of the sale of practices, which leads to a question of whether compensation should or should not be paid. would be out of Order.

Mr. Henry Strauss (Combined English Universities): Is it not clearly in Order, Major Milner, under paragraph (b) of the Resolution to say that the whole of the expenditure under that paragraph would be unnecessary, if the Bill were more rationally drafted to achieve its objects? Does not that permit quite a wide discussion on the merits of the effect of this Bill on the doctor-patient relationship; and is not it rather significant that, at an earlier stage today, the Lord President of the Council called attention to the fact that there would be an opportunity of discussion on the Financial Resolution, to show how much time had been allowed for the discussion of the merits of the Bill?

The Minister of Health (Mr. Aneurin Bevan): May I ask, if the last submission is correct, what is the difference between a Debate on the Money Resolution and a Debate on the Bill?

The Chairman: The difference is that the present Debate must, of course, relate to the purposes set out in the Financial Resolution and to the desirability or otherwise of providing those moneys for those purposes. It would not be in Order to go beyond those purposes.

Mr. Law: I must thank you, Major Milner, for your Ruling. I do not think that I have so far transgressed it, and I hope I shall not transgress it in anything I have to say now. What I suggest that the Committee has to consider is whether this payment of £66 million is necessary. The argument put forward from the other side of the Committee is that it is necessary to prohibit the buying and selling of practices, because only in that way can a fair and even distribution of practices be secured throughout the country as a whole, and as between one district in the country and another district. The point I put to the Committee is, that there is little evidence to suggest that the machinery to do with the distribution of practices—

Mr. S. Silverman: On a point of Order. I do not want to be persistent, Major Milner, but I should like to have your Ruling on this point. It is perfectly clear now that the right hon. Gentleman is inviting the Committee to discuss whether or not there should be a prohibition on the sale of practices. I submit to you with great respect that any such discussion at this stage would be out of Order. All we are entitled to discuss now, having decided that there should be such a prohibition, is. Shall we compensate or not?

The Chairman: On that point I think the hon. Member is quite right. The right hon. Gentleman ought not to discuss the merits of prohibition further.

Mr. Law: Surely, I may submit with great respect that the only reason that this payment is called for, is because the Government have decided that the buying—

Mr. Bevan: The House has decided.

Mr. Law: The House will have an opportunity of reconsidering it.

Mr. Bevan: May I submit respectfully that the House will get no opportunity on a Money Resolution of reconsidering the decision? What the Committee has now got an opportunity of doing, is to determine whether or not compensation should be paid, and if so how much.

Mr. Law: With great respect, I am not moving an Amendment to the Financial Resolution which would undo any decision to which the House has come. Indeed, the House has not come to any final decision on this matter, and, presumably, will not come to a final decision until we dispose of the Bill altogether. I cannot see how it is possible to discuss this principle of the payment of £66 million to medical practitioners unless one can also discuss the reasons which make this payment necessary.

The Chairman: The right hon. Gentleman must relate his remarks arising out of the prohibition of the buying and selling of practices to the provision or non-provision of the money for compensation. If he can do that he will be in Order.

Earl Winterton: On a point of Order. In answer to the point made by the Minister of Health, would not the logical outcome of what he was saying be for the Committee to refuse to vote this money? In fact, if the Committee refuses to vote the money the Bill passes into desuetude and cannot be passed. Until the money is passed by the Committee the Bill cannot come into operation.

The Chairman: That may or may not be so because there are many matters in the Bill on which the question of money or compensation does not arise and discussions on those matters would not be in Order on this Motion.

Mr. Silverman: If the House did not pass the Money Resolution the only effect on the Bill would be that we would not pay compensation. It would not affect at all the prohibition on buying and selling practices.

7.15 p.m.

Mr. Henry Strauss: In answer to the last point, there have been many cases in the past where the Rules of the House have not been so narrowly interpreted. In my submission, the discussion is not as limited as it would be if we were

moving to omit one particular part of the Resolution. I submit that the Noble Lord is right in his submission that we can take the merits of this Financial Resolution as a whole and discuss them. While I entirely submit to the Ruling you, Major Milner, have given that anything not involved in the Financial Resolution would be irrelevant, surely the merits of the Bill which lead to the particular financial provisions presented here are open for discussion.

Mr. Bevan: No.

Mr. Strauss: Hon. Members on the other side of the Committee seem to think we are not entitled to make our case, but in my submission we have a perfect right to do so Hon. Gentlemen opposite are trying to prevent a discussion, notwithstanding the statement of the Lord President of the Council that there would be an opportunity on the Financial Resolution for discussion. I submit that the general merits of those parts of the Bill which are involved and are implicitly mentioned in the Financial Resolution are open to discussions and I should welcome your Ruling, Major Milner, on that point.

Mr. Bevan: May I make a submission to you, Major Milner, before you give your Ruling? I have taken part in many discussions on Financial Resolutions in the House. Many of those discussions have been exceedingly protracted and quite detailed, but they have been on occasions when the Financial Resolution has included such large portions of the Bill, that unless there were adequate discussion on the Money Resolution, there would have been no proper opportunity for discussion at all of the principles involved. On this occasion a different situation exists. When this Bill goes into Committee upstairs very wide discussion is permitted, because the Financial Resolution will not prevent discussion on a very wide range of principles. In my respectful submission, it would be an abuse of the procedure of the House if we had a wide discussion on the principles of the Bill, and on the principle of the buying and selling of practices on Second Reading, another long discussion on the Money Resolution on the principle of the buying and selling of practices, and another long discussion on the same subject in the Committee upstairs. Hon.


Members opposite, having got considerable latitude, ought, I think, to accept the limitation of the discussion now.

Mr. J. S. C. Reid (Glasgow, Hillhead): Before we come to a decision, I venture to suggest that this is the position. The House obviously has not decided either that there shall or shall not be prohibition on the sale of practices, because if it had so decided, it would be incompetent to discuss it again in Committee. We are all agreed it is competent, in Committee, to discuss the Clause in the Bill which deals with the question of whether or not there should be a prohibition on the sale of practices. Therefore, it follows that the House has not yet decided that matter. The House has given general approval to the principles of the Bill, but has not decided in favour of any one of those principles. Any one of them can be omitted by the Committee upstairs without infringing the decision of the House. That is the first point. If the House has not decided this matter, it is open to us here to discuss the question of whether or not it is necessary or desirable to spend £66 million, or whether it is desirable to delete the provision in the Bill which makes that expenditure necessary. It is, therefore, in Order, I submit, to say that this expenditure is wholly unnecessary, because the purpose for which it is to be used is unnecessary. Surely, it is possible for this Committee to argue the question that this expenditure should not be authorised, because the purpose for which it is intended to be used is a bad purpose. There are two possible arguments, and only two, which would be open in this Committee. One is that the money to be spent is too much; the other is that the purpose is a bad purpose, and that no money should be spent. I have never heard that in a Committee dealing with the expenditure of money it is irrelevant to argue that money should not be expended, because the purpose was a bad one.

Mr. S. Silverman: If the arguments addressed to the Committee by the hon and learned Member for Norwich (Mr. H. Strauss) and the right hon. and learned Member for Hillhead (Mr. J. S. C. Reid) were correct, the logical conclusion would be that we could debate, on the Financial Resolution, every single point in the Bill.

We could have the Second Reading Debate all over again. If it is in Order to discuss the merits of the prohibition of the sale of practices, then we are entitled to discuss the merits of every other point in the Bill. That is the reductio ad absurdum of the argument. If the right hon. and learned Gentleman says we are entitled to discuss whether the expenditure is necessary or unnecessary, I respectfully agree, but the question whether it is necessary or unnecessary arises out of the question whether it is necessary or wise to pay compensation after we have prohibited the sale of practices.

Earl Winterton: The assumption of hon. Members opposite seems to be that because a Bill has passed its Second Reading none of its provisions can subsequently be discussed. [HON. MEMBERS: "No."] The whole purpose of the Financial Resolution and the Committee stage is, I submit—arguing from long historical continuity—not only to discuss the manner in which the money should be spent, but the purpose for which it is being voted, and Members are entitled to say that the purpose is a bad one.

The Chairman: The Noble Lord is quite right as regards his second point. The money is provided for, among other things, compensation for certain purposes, and the question of compensation is open to discussion. But the general merits of the Bill, or the question of imposing prohibition on the sale of practices, are not open for discussion

Mr. Law: I must accept your Ruling, Major Milner. I understand that I could argue, if I wished, that compensation should not be payable to medical practitioners, which is certainly not what I or any Member of the Committee would want to argue, but that I cannot argue at all about the set of facts which make possible payment of that compensation.

The Chairman: May I be more precise? The right hon. Gentleman cannot argue whether the sale of practices is or is not a good thing. He may argue that compensation should or should not be provided, and that the moneys should or should not be provided for the purposes of that compensation, but not that the sale of practices is or is not a good thing. I hope I have made the point clear.

Mr. Henry Strauss: Further to that point, Major Milner—

The Chairman: I have given my Ruling. Hon. Members on both sides of the Committee have had the opportunity of making representations to me on this matter, and I must ask the right hon. Gentleman the Member for South Kensington (Mr. Law) to continue his speech.

Earl Winterton: Surely you do not mean, Major Milner, that an hon. Member is not entitled to raise another point of Order. With respect, I. submit that that would be an entirely novel Ruling from the Chair. I have frequently seen the discussion on points of Order, arising out of a Financial Resolution, last for over two hours.

Mr. Strauss: I wished to put a question, Major Milner, as I did not quite follow your Ruling. I thought you said that it would not be permissible to discuss whether practices should or should not be sold, but cannot we discuss the wisdom of paragraph (b) of the Financial Resolution with regard to
…provision of the said Act prohibiting the sale of medical practices …?
Is it not in Order to discuss the merits of that paragraph? Before you give your Ruling on that, Major Milner, may I say, in answer to the point put by the Minister—for whose knowledge of points of procedure I have great respect, because I remember how he used to deal with them when he was on this side of the Chamber—that I do not complain of the narrowness of the terms in which the Financial Resolution has been drawn. But it contains the words which I have just quoted with regard to the Act prohibiting the sale of medical practices, and I would like to know whether it is your Ruling, Major Milner, that we must not discuss the merits of these provisions.

The Chairman: My Ruling was that the Committee cannot discuss the merits of such a prohibition, but can only discuss the question of whether compensation should or should not be paid in respect thereof.

Mr. Reid: Further to that point, Major Milner, would it be in Order to argue on this line, which seems a feasible line of argument, but which I do not want to open until you have given your Ruling? Suppose I say, as I am entitled to say, "You ought not to prohibit the sale of practices except in areas which have been proved to be over doctored; that those areas are much less than half the country,

and that we could, therefore, save much more than half of the £66 million if you limited this prohibition." Suppose I were to say, "You could save much more than half this £66 million if you would adopt the line of limiting the provisions in the Bill which deal with this point to the areas where they are necessary, and in that way save the country £30 million or £40 million." Surely I would be entitled to argue that?

Mr. S. Silverman: May I submit, with respect, Major Milner, that that would be a perfectly good argument on the Second Reading, or in Committee, when our minds were being directed as to whether there ought or ought not to be prohibition of the sale of practices, but that it is completely irrelevant on the question of whether we ought to provide money to compensate.

The Chairman: The right hon. and learned Gentleman may of course argue that compensation should be limited in some respects and give reasons. He would then be in Order, but he would not be in Order in arguing that prohibition, as such, should or should not be imposed.

Mr. Reid: I am afraid I have not quite followed your Ruling, Major Milner. The only reason I want to argue to limit the sum of £66 million is because the provisions under the Bill should he limited to areas of proved necessity. I want to argue that £66 million is extravagant on that ground. I am not sure, Major Milner, whether your Ruling allows me to develop the argument, and to ask the Minister for information about the extent of the areas of proved necessity, and so on; but I submit it would be relevant to raise this matter, because it is very directly relevant to the expenditure by the nation.

7.30 p.m.

Mr. Bevan: Further to the point of Order, I submit that if the right hon. and learned Gentleman were permitted to put an argument of that sort to the Committee and I were expected to reply to it, I should have to argue that in a given area it was desirable to prohibit the sale and purchase of practices and that in another area it was not desirable to do so, and therefore, there would be an argument as to why it would be desirable in one area and not in another, and before we knew where we were, we should be arguing whether or not it was desirable to prohibit


the sale and purchase of practices. My submission is that the position that is now being taken up by hon. Members opposite is one of considerable intransigence.
I have heard earlier discussions about Money Resolutions, and the Noble Lord will have heard them on many occasions. There was very considerable difficulty before the width of Financial Resolutions was altered in the time of the late Mr. Speaker Fitzroy. Objection was taken over and over again on the ground that Money Resolutions embraced so much of the Bill as to deny effective debate on the Committee stage of the Bill, and at that time Mr. Speaker Fitzroy said that it would be extremely difficult for him to give Rulings on the discussion of a Money Resolution if so much was embraced in it, and he asked Members of the Government to consider drafting Money Resolutions as narrowly, or as widely—one can take whichever word one pleases—as possible, leaving as much as possible of the Bill out of the Money Resolution in order not to prohibit discussion on the Committee stage. This is a very important matter concerning the freedom of the House. That was done. The Government have taken very good note of it, and this Money Resolution is drawn in such a fashion as hardly to curtail at all the power of the Committee when it comes to consider these principles; but if hon. Members opposite want to have it both ways, if they want to have a Money Resolution so drawn as to give them wide discussion on the Committee stage and so interpreted as to give them wide discussion on the Money Resolution, the Government will have to reconsider the whole drafting of Money Resolutions.

Mr. Henry Strauss: With everything that the right hon. Gentleman the Minister of Health said, until he came to the end of his remarks, I respectfully agree. Money Resolutions, when they were drawn too narrowly—I think that is perhaps the better word—did curb discussion on the Committee stage of the Bill. We do not accuse the Government of doing that in this Money Resolution. But the idea that we have to be limited in this discussion astonishes me, when it comes from the right hon. Gentleman the Minister of Health, who is an able debater, and has hitherto shown no anxiety at the pros-


pect of an evening's debate. May I point out, in substantiation of the submissions that have been made from this side of the Committee, that the Money Resolution is in the name of the Financial Secretary to the Treasury, who is very seldom on the Bench to take any part in the proceedings on a Financial Resolution, for the reason that, although it is in his name, it is well known that the Minister in charge of the Bill is the Minister who has to be prepared to deal with all the subjects arising under it? As far as I know, from some experience in the Government, every Minister, coming to the Committee with a Financial Resolution, comes armed from the Department to discuss the merits of anything in the Bill that may arise on the Financial Resolution, which would be wholly unnecessary if the discussion were so limited as the right hon. Gentleman suggests.

The Chairman: I am sorry but I am sure the hon. and learned Gentleman the Member for the Combined English Universities (Mr. Henry Strauss) appreciates that whatever brief the Minister may have must be a brief relating to the matters contained in the Money Resolution, and not, as he said, on the merits of anything in the Bill. The Committee may discuss the question of compensation, but it may not discuss the prohibition of the sale and purchase of practices which was the point originally raised and the point to which the right hon. Gentleman was relating his remarks.

Mr. Law: I will not pursue the merits of this proposal concerning the sale and purchase of practices any further, because obviously it would go against your Ruling under this paragraph, Major Milner, but it seems to me extremely odd that the Government should have provided half a day for the discussion of this Money Resolution, and that, at the same time, they should have been so determined that the real merits of this payment of £66 million should not be discussed. I accept your Ruling, Major Milner, but what strikes me as odd, is that the Government, having given the Committee a half day to discuss the Money Resolution, should then seek, as the Minister is seeking, and as the hon. Member for Nelson and Colne (Mr. Silverman) is seeking, to stifle and limit discussion.

Mr. S. Silverman: I would point out to the right hon. Gentleman that I inter-


vened on my own initiative and that none of my hon. or right hon. Friends knew that I would do so. I did not myself know I would do it until the right hon. Gentleman began his speech. As to stifling discussion, on the contrary, I want discussion to go on, but I want it to be relevant to the point whether we ought to provide £66 million of public money to compensate people for the loss of something which they never had.

Mr. Law: I do not propose to follow the hon. Member in that, and it would, in fact, be out of Order to do so. I think it is fair to comment that the Government have not allowed this Bill to go to a Committee of the Whole House, although it is a Bill which affects every member of the population. The Minister has been very careful to limit discussion of this particular proposal. However, I will leave paragraph (b), and I would like to deal with paragraph (e) of the Money Resolution. This paragraph makes provision for expenses incurred by other bodies constituted under the Act. One of the bodies for which provision is made is the Medical Practices Committee. it seems to me that it is unnecessary to make provision for the Medical Practices Committee because that Committee is not in itself necessary to the Bill and to the constitution of a comprehensive health service. Am I in Order in arguing that, Major Milner?

Mr. Bevan: Before you give your Ruling, Major Milner, may I say that the decision to constitute the Medical:Practices Committee has been determined provisionally by the Second Reading decision. What would be in Order, in my respectful submission, would be to discuss the amount and the form of the expenses to be paid, but not the principle of having a Medical Practices Committee.

Mr. S. Silverman: I submit that it would be just as much out of Order to discuss the merits of the Medical Practices Committee as to discuss the merits of the prohibition of the sale and purchase of practices. What we are discussing on the Money Resolution is the financial consequences of what was decided on the Second Reading of the Bill.

Mr. J. S. C. Reid: Surely, Major Milner, there is this essential difference between the two. One can knock out the £66

million and still leave operative the parts of the Bill which deal with the prohibition of the sale and purchase of practices The two things do not necessarily go together although we think they ought to do so in equity, and so does the Minister; but if one knocks out the expenses of the Medical Practices Committee, one destroys the Committee, because the Committee cannot go on without expenses. Therefore, there is a much closer linking here between the provision of the money and the purpose than there was in the other matter. The two things necessarily go together, and if one is to do more than say, "We think these expenses should not be paid at all by the Government," one cannot utter another sentence on that question without raising the matter of the existence of the Committee, and that means reference to the functions of the Medical Practices Committee.
It may be that your Ruling, Major Milner, will be that we cannot utter a single sentence relevant to this paragraph of the Financial Resolution without getting out of Order, but I submit that, unlike the other case, any Ruling which bars any discussion of the functions of the Medical Practices Committee completely stifles the discussions of this Committee on this part of the Resolution.

The Chairman: If that be so, so be it. In my view, the discussion is clearly limited to the desirability or otherwise of paying the expenses, and should not deal with whether the setting up of a Medical Practices Committee is or is not a good thing. The right hon. and learned Gentleman will agree with me, I am sure, that it is correct to say that even if the expenses were not paid the Medical Practices Committee might conceivably not disappear. In any event, it might be a voluntary Committee. It is quite clear that the merits or demerits of having such a committee cannot be discussed here, but only the question of whether or not the expenses should be paid.

Earl Winterton: Could you elaborate this point at a little more length, Major Milner? Is it possible to discuss whether or not money should be voted if one cannot, at the same time, discuss the purpose for which it is being voted?

The Chairman: A hypothetical question like that hardly needs an answer, but it


is quite clear in my mind that it is not appropriate at this stage—particularly as we have discussed the Bill for two and a half days—to deal with the merits or demerits of proposals which do not directly affect the desirability of paying or the amount of the compensation, which may or may not be authorised.

Mr. Reid: I do not know whether you meant to use the word, Major Milner, but you said that in view of the discussions over the last two and a half days it would not be "appropriate" to have a discussion now. I had thought that it could be either in Order or out of Order, and that it was not a question of whether it was appropriate or inappropriate. I should not like that phrase to stand, if you really meant it was out of Order and your reference to what had taken place during the last two and a half days was irrelevant to your Ruling. If that is so I suggest that you should put your Ruling on another point.

Hon. Members: That is an insult.

The Chairman: The right hon. and learned Member is quite right and the phrase I used was not a happy one. The question as to whether the discussion lasted two and a half days or not was not relevant, and I have to consider the rule of relevancy, and it is on that that I base my Ruling.

Mr. Law: Perhaps I may be allowed to say, in respect of paragraph (e) of the Financial Resolution, that it seems to me that to vote expenditure for some of the bodies which are set up by this Bill is perhaps an undesirable and unfortunate thing to do, because though it may be perfectly true, as you have indicated, Major Milner, that these bodies might continue without any financial support behind them, I think the probability is that they will be much less harmful if they continue on that basis. From that point of view I feel that in some cases it would be desirable not to provide for their expenses, and one of these bodies I suggest is the Medical Practices Committee for which I can see no necessity, because I do not believe that it is an effective method of distributing doctors throughout the country. I think it would be interesting before we leave the Financial Resolution if the Minister could tell us a little more than he was able to on Second Reading—although

I do not know if he can—about the functions and scope of some of these bodies.

The Chairman: That is precisely what I do not think I can allow the right hon. Gentleman to do in detail on this Resolution.

7.45 p.m.

Dr. Morgan (Rochdale): And the right hon. Gentleman knows it.

Mr. Law: Once again I must, naturally, accept your Ruling, Mayor Milner. I find it very difficult within the limits laid down by the Financial Resolution to make such criticism of some of these expenses as I would be able to make if the Resolution were differently drawn. I can only say that we shall discuss these matters which I am prohibited from discussing now at another stage in the Bill and, I hope, at full length.

Major Guy Lloyd (Renfrew, Eastern): I have listened for two and a half days to discussions on the general merits of the Bill in which I took no part, because the Bill applies to England and Wales but not to Scotland as yet, although it is a prototype of what is in store for Scotland some day. On the Financial Memorandum and on the Financial Resolution I am more ready to say a word or two because Scotland is affected to some extent. Personally, I have never heard of any Bill of such a revolutionary and far-reaching character presented to the House of Commons with such a grossly inadequate estimate of its ultimate total cost to the nation. All the way through the Financial Memorandum there is complete and utter vagueness on what the scheme is likely to cost. Neither the Government, nor the Minister, nor the Department, nor the nation, nor the taxpayer have the slightest idea of the vast expense which this huge revolutionary Bill is likely to cost the nation early and late and in years to come. All the way through the Financial Memorandum this vagueness is exemplified. In the second paragraph there is this statement, typical of many others with so many unknown factors:
any estimate of the cost of the new Service is necessarily conjectural.
That is characteristic of the whole estimating in the Financial Memorandum and the financial part of the Bill which we are discussing now. Paragraph 3 of the Memorandum says:


No estimate of the capital value of these [hospital] assets can be made,
and further on in the same paragraph we find:
No precise estimate of the net value of these endowments"—
that is, the endowments which are being "pinched" by the Minister from the hospitals of the country, very much in the same way as Henry VIII "pinched" and sequestrated the endowments from the monasteries.

The Chairman: The hon. and gallant Member no doubt appreciates that there is nothing on that subject in the Financial Resolution, and that therefore his argument is not only inappropriate but irrelevant.

Major Lloyd: I accept your Ruling, Major Milner, but—

Mr. Butcher (Holland with Boston): Surely the point raised by my hon. and gallant Friend is covered by the final words of the Financial Resolution:
To authorise the payment into the Exchequer of sums received by the Minister of Health under the said Act.

The Chairman: Incidentally I think I am right in saying that the sums to which the hon. and gallant Member was referring are not authorised by this Resolution for payment into the Exchequer.

Major Lloyd: Perhaps I might now continue my line of argument, which was relevant, namely, that the estimates of expenditure are grossly underrated and that, in fact, Parliament is being asked once again to buy a pig in a poke. I want to point out still further vagueness. The Memorandum says:
The net value of the investments of the voluntary hospitals which will he transferred to the Fund has not been ascertained.''
Nobody knows what money is coming into the Exchequer in this connection. Later, paragraph 7 of the Financial Memorandum states:
Scales of salaries and payments have not yet been settled so no exact estimate is possible but it is anticipated that the annual cost of these services at the commencement of the schemes will be about £45 millions.
Nobody knows, in any form or shape, how much that £45 million will be increased in due course. Later, to continue this part of my argument, the Memorandum says:
No estimate can yet be made of the expenditure to be incurred in respect of the pro-

vision for superannuation or compensation but as explained in paragraph 7 it may be necessary to make certain payments.

So again, there is complete vagueness. Finally, there are these words:
The total annual expenditure falling on the Exchequer and the local authorities during the early years of the operation of the service is.…
In the early years only. Later on, nobody knows; but if I were to predict that the expenditure outlined in the White Paper as £152 million in the early years, might even be doubled before the next 10, 15 or 20 years, nobody would know and nobody would care whether that statement was true. I protest that a Bill so vaguely estimated and with such far-reaching social and financial consequences to the country should be presented in this way to the House of Commons. Scotland is deeply affected. To have a Bill presented for England and Wales—"

The Chairman: I must point out that Scotland does not come into the Bill, and therefore is not covered by the Financial Resolution

Major Lloyd: I agree with that, of course, Major Milner, but if the sums of money that we are now being asked to pass are grossly under-estimated for the cost of a Bill to which we have just given a Second Reading, I am entitled to protest. I do suggest that the sums that we are being asked to pass are grossly under-estimated. They may not be 50 per cent, of what the taxpayer will eventually be called upon to pay. I accordingly protest from this side of the Committee. If the Scottish Bill, when it comes along, is to be estimated—

The Chairman: rose—

Mr. Kirkwood (Dumbarton Burghs): Why not get someone on that side of the Committee who can speak without getting out of Order?

Major Lloyd: I appreciate your anxiety, Major Milner, but I desire to express the greatest apprehension with regard to what may be in store for Scotland in future. I conclude by making my protest on behalf of Scotland at the abominable way in which England and Wales have been treated.

Mr. Eric Fletcher (Islington, East): After the rather inglorious attempts of


two Members opposite to make speeches that were in Order upon this Financial Resolution, I venture, with some diffidence, to rise to present one or two points which I hope will be in Order, and in respect of which I hope the Committee will receive assurances from the Minister. There are certain matters which are raised in this Bill, and not ventilated during the Second Reading Debate, that are of vital concern to local authorities. I believe that the points I wish to raise in connection with them can be properly discussed at this stage of the proceedings.
The White Paper which preceded the Bill pointed out that the proposals of the Bill would affect not only the activities of local authorities but also radically affect their financial relations with the Exchequer. As I understand the Financial Resolution, one of its objects is to authorise the payment, out of money provided by Parliament of
expenses incurred by the Minister of Health in the exercise of his functions under the said Act.
I want first to refer to the expenditure which will all upon the Minister in fulfilling his obligations under Cause 6 (2) of the Bill, which provides that, on the appointed day, there shall be transferred to the Minister
all hospitals vested in a local authority immediately before the appointed day, including all property and liabilities held by the local authority, or to which that authority were subject, immediately before the appointed day, being property and liabilities held or incurred solely for the purposes of those hospitals or any of them 
I apprehend that when questions come to be discussed between the Minister and local authorities owning hospitals which will be transferred, differences of opinion may well arise as to the liabilities which shall be taken over by the Minister, or for which compensation shall be provided out of moneys provided by Parliament. I want to ask for assurances from the Minister regarding matters which will concern a number of local authorities.
Let me take the case of the London County Council, with which I am most familiar, and which, being the owner at present of something like 100 hospitals, including mental hospitals, will have to consider a financial problem which will no doubt, in various degrees, face other local authorities. The problem is this: A local

authority owns a considerable amount of property—offices, hospitals, schools, depots and property of other kinds. None of these institutions are specifically mortgaged or charged in the sense that liabilities are incurred solely in respect of them. The assets and liabilities of the London County Council are treated as a whole. Their debt obligations are charged on the whole of their assets and on their rates. Of course they have, like other corporations, an internal book-keeping system which records for internal purposes the relative obligations and loan charges still outstanding in respect of various assets. But I can understand that an argument may well arise between the Minister and a particular local authority as to the extent of the liabilities which shall be taken over under Clause 6.
8.0 p.m.
I want therefore to ask, first, whether it is contemplated that regulations will be made to provide some independent arbitration for solving disputes of this kind which do not prove susceptible of agreement between the parties. Clause 6 (5) empowers the Minister to make regulations for certain matters and finally provides for the determination by arbitration of any matter arising "as to any of the matters aforesaid." As I understand it, Subsection (5, d) is limited in its application to Subsection 5 and does not provide for arbitration on disputes of the kind I have in mind under Clause 6 (2). May I give a specific illustration of a problem which will produce hardship and inequity unless it is dealt with? The London County Council, which has enjoyed a Labour majority for a number of years and has, therefore, had its financial affairs governed by prudent and well-organised methods, has over a long period met direct out of revenue considerable capital sums in respect of the property now to be transferred. In other words, it has met, in advance, capital expenditure out of revenue account and has provided out of the rates a certain sum of money every year not merely for revenue purposes but for capital expenditure.
No doubt, other local authorities have adopted the same method, which has been encouraged and welcomed by successive Governments. The result is that by reason of having provided these sums out of revenue, the present liability on loan charge and so forth due from the London County Council in respect of their 100 or so hos-




pitals is some £3 million less than it otherwise would have been. I hope we can receive an assurance from the Minister that the London County Council and other authorities in similar circumstances will not be prejudiced by the sound financial methods they have adopted in the past. It would be most unfortunate if local authorities were to be penalised for the soundness of past financial policy. I hope the Minister will give us an assurance on that matter.
The second point I wish to raise arises under Clause 53. I apologise for the fact that it is a little complicated. Under Clause 53 (4), provision is made for local authorities to pay to the Exchequer certain sums of money, namely:
a sum equal to the loss on account of the grants mentioned in paragraph 2 of the Second Schedule of the Local Government Act, 1929.
Put shortly, the position is this. Prior to 1929, local authorities were responsible for certain health services such as tuberculosis, mental deficiency, venereal diseases, maternity and child welfare and other matters, in respect of which they received a contribution or subvention from the Exchequer equal, in most cases, to 50 per cent. of their expenditure, and in the case of one or two items, such as venereal diseases, 75 per cent.
In 1929, when the block grant system was introduced, these specific contributions from the Exchequer disappeared. The global amount which the Exchequer had hitherto paid to local authorities was added to or merged into the block grant, and, therefore, being in the block grant, that amount was then spread out among the local authorities according to the formula provided under the block grant system for the distribution of money among local authorities. The result was that some authorities got less and other authorities got more than they had before. If the provisions of Clause 53 (4) stand as at present, the result will be that all local authorities have, in future, to make a payment to the Treasury of the sums which they lost in 1929, although some of them have received more by way of their share out of the block grants and others have received substantially less. I hope this matter will also be dealt with during the Committee stage.
Finally, while local authorities have no doubt noticed and welcomed the para-

graph in the White Paper, paragraph 103, which indicates that the whole question of Exchequer grants in aid of local authorities is under consideration by the Government, I think it is appropriate at this stage to make this comment. The net effect of this Bill is, of course, to transfer hospital and other medical services from local authorities to the State. To that extent it involves an Exchequer burden and a further contribution by the taxpayer, but local authorities and ratepayers will expect, by reason of no longer being responsible for providing health services, that there will he a corresponding reduction of the burden on the ratepayers. It would be unfortunate if any suggestion were to get abroad that the savings which will result locally to local authorities by reason of the transfer of these functions to the State will not be fully available to them. I hope we may also receive assurances from the Minister about this.

Mr. David Renton (Huntingdon): I should like to congratulate the hon. Member for East Islington (Mr. E. Fletcher) upon staying the course without having objection raised against him. I am a mere Parliamentary yearling; the course is not very well defined, and I have never been over it before on a Financial Resolution. The point which I have to raise is a severely practical one and it arises from the fact that the appointed day under this Bill, or the day on which the Order in Council is to be made, will not be for a very long time, sometime at the beginning of 1948, it is hoped—so the White Paper says. In that time a great deal can happen, and I am sure that the Minister would wish that when he takes over the voluntary hospitals, he should take them over in at least as flourishing a state as they are now and possibly we may wish to see them improved. I regret to say that in my ignorance—I shall be grateful for enlightenment—I do not know whether there are arrangements already existing under the authority of Parliament whereby the Minister, if he finds that a voluntary hospital is in severe need of funds, can immediately pay out money to it. If there are not such arrangements, it remains to consider whether any help can be given under the terms of this Financial Resolution. I submit that that matter arises for consideration whether funds continue to be received by the voluntary


hospitals or not. We naturally hope that they will continue to receive them both before and after the appointed day, but in the unhappy event of some of the funds falling off, it is desirable to see that in the considerable intervening space the voluntary hospitals will not suffer.
My second point is this: Presumably the Financial Memorandum as an introduction to the Bill should be read with this Financial Resolution, and Parliament, when deciding whether or not to pass the Financial Resolution, must look at the Financial Memorandum in order to see what, roughly, is the extent of its commitments. We are gravely handicapped in considering what our commitments will be because of the fact that in the Financial Memorandum some of the most important items are the merest estimates and are dependent upon the publication of the Spens Report. I know it would be contravening my humble position to suggest that consideration of this matter should be adjourned in order that we may await the Spens Report, but nevertheless I am sure the Committee would appreciate it if the Minister could give some indication whether he considers himself already bound by the approximate figures given in the Financial Memorandum, or whether he will be prepared, when he sees the Spens Report, to modify them, as may be necessary, upwards or downwards.

Major Peter Roberts (Sheffield, Ecclesall): I wish to go back to the question of the £66 million under paragraph (b) and, on the Ruling which we have just had, I shall be in Order because I wish to delete it from the Financial Resolution. I do so to draw attention to the tactics of the Socialist Government in trying to put over their Socialist nationalisation theories. In the past, the idea of State ownership has been advocated by the theorists on the other side. It has had very little appeal to the masses of the people. [Laughter.] Hon. Members laugh. The reason they are on that side of the Committee is because of the promises of demobilisation, and—

The Deputy-Chairman (Mr. Hubert Beaumont): The hon. and gallant Member, very early in his speech, is departing from the Financial Resolution. Will lie come back to it?

Major Roberts: I am sorry, Mr. Beaumont. I was provoked by unnecessary laughter from the other side. The second form of criticism to such a Resolution as this has been, of course, the voices of those technical or professional people in the various industries or professions which are taken over. Now the Government have changed their tactics from confiscation to compensation. This is very relevant because it is on this question of the £66 million compensation which I wish, if I am in Order, to speak. The Minister, in his Second Reading speech, referring to this question of compensation, said that he did it out of fairness. I wish to state quite definitely that that, in my opinion, is humbug and hypocrisy. The reason why he has put this in is that I do not think, knowing him so well, that he would lose an opportunity to strike a blow in the battle of class hatred unless he had some very subtle motive behind—

The Deputy-Chairman: I do wish the hon. and gallant Member would make his points on the Financial Resolution and not continue to depart from it.

Major Roberts: I submit, Mr. Beaumont, that I am trying to point out the reason why the Minister has put in this £66 million and the reason why I want to take it out. With respect, it is not out of Order, because I am trying to argue that this should be taken out—

The Deputy-Chairman: I hope the hon. and gallant Member is not challenging my Ruling.

Major Roberts: Oh, no.

The Deputy-Chairman: That being so. he may continue.

8.15 p.m.

Major Roberts: I wish to pass, then, to my second point. The Minister, in my submission, by putting in this amount of £66 million was hoping to stifle the criticisms which might be levelled against him had he not put it in. Can the Minister deny that he raised the "ante" day by day, million by million, until he reached this figure? I put that to him. I put to him further that this figure of £66 million is practically the top price which the taxpayers are being asked to pay, and the fundamental point is that the Government are using the taxpayers' money, mey are using the consumers' money in other industries in order to put over their


Socialist ideas. I submit that that is one example—

The Deputy-Chairman: Really, if the hon. and gallant Member does not keep to the Financial Resolution, I shall have to ask him to resume his seat.

Major Roberts: I bow to that Ruling, Mr. Beaumont, but I find it very difficult to put over the arguments why I wish to reduce the £66 million. Those are the arguments to which I am addressing myself and I hope, with your Ruling, Mr. Beaumont, that I shall be able to keep in Order. I do not wish to be taken up by the Minister and misrepresented in what I am saying. I am not saying that if such a scheme with compensation in it is to go through, that compensation should not be paid; I am saying that this Financial Resolution, as drafted, can perfectly well work for a universal national health scheme without this provision in it. The reason why I want to reject this £66 million is to make the Minister reconsider, which it is his duty to do, other ways and means by which he can bring about this comprehensive health service which we all want without putting this enormous capital amount upon the taxpayers and the consumers of this country.

Sir Wavell Wakefield (St. Marylebone): There are four points I want to raise which are the financial consequences of the principles which have been approved in the Second Reading of this Bill, and I hope the Minister, in his reply, will be able to give the answers to my points. In this Financial Resolution moneys will be expended for equipment at health centres. Will private practitioners be able to use that for their private patients or will a charge be made for the use of such equipment to reimburse some of the moneys spent under this Financial Memorandum? I do not know whether I have made myself clear, but it is an important point. This equipment will be right up to date. Will fee-paying patients of practitioners be able to use it? Such patients have already, in the payments they make under this scheme, become entitled to the advantages of the public service and if they pay extra to some other practitioner for other treatment, surely they ought to be entitled to the use of it. If the Minister could give some information on that point, it would be very helpful. My second point is this: In the moneys to be spent under the Financial Resolution

is a substantial amount to be set aside by way of scholarships or in any other way, to enable young men to qualify as medical practitioners, as they are not now able to qualify? This point was raised on the Second Reading and if the principle is approved it is of the utmost importance that every young man who wants to qualify and has the promise of ability to qualify—

The Deputy-Chairman: I am rather puzzled as to how the hon. Member relates what he is saying to the terms of the Financial Resolution. Perhaps he will indicate to me to which section of the Financial Resolution he is now referring?

Sir W. Wakefield: I am asking if this position will be covered, I think it is under paragraph (e):
Expenses incurred by other bodies constitued under the said Act.
What I am trying to obtain from the Minister is information as to whether some of these moneys will be expended in this very important initial educational work. Otherwise, I do not see how the principles which we have approved, can possibly be implemented in the way the Minister indicated in his opening speech in the Second Reading Debate.

Mr. Bevan: This, in my submission, is quite out of Order. The Minister of Health has no direct responsibility to provide money for training of doctors. That is the responsibility of the Ministry of Education.

Sir W. Wakefield: That has answered the point on which I was seeking information. We now know that what we approved in Second Reading cannot be fully implemented.
The third point is, can the Minister give some information as to whether some moneys will he provided under the Financial Resolution for compensating people who have contributed to various sick funds and hospital savings schemes? Money has been subscribed to such schemes and credits have been given to those people. Is any provision made for the reimbursement of those contributors, when the Bill becomes an Act? In the meantime, could the Minister indicate whether contributions should be continued?

The Deputy-Chairman: I am sorry but I cannot see that what the hon. Member


is saying now is in Order at all. It does not come within the terms of the Financial Resolution. We are discussing, moneys to be provided by Parliament.

Sir W. Wakefield: With respect, I am trying to find out whether money will be provided under this Financial Resolution for this purpose, which is very important. People want to know the position. The very vagueness of this Measure, to which the hon. and gallant Member for East Renfrew (Major Lloyd) referred, is my justification for raising this point.

The Deputy-Chairman: The hon. Member is dealing with a point which should have been brought up on Second Reading, or which can be brought out on the Committee stage. It cannot be dealt with on the Financial Resolution.

Sir W. Wakefield: My time was somewhat curtailed on the Second Reading Debate and I thought that in the circumstances, because of the importance of this matter, I would be in Order in mentioning it now.

Mr. S. Silverman: On a point of Order. May I ask whether it is in Order in a discussion on the Financial Resolution to make all the speeches we would like to have made on Second Reading?

The Deputy-Chairman: It would not be in Order, and it would not be permitted. The hon. Member has had a fairly long run. Will he now deal with any points arising out of the Financial Resolution?

Sir W. Wakefield: I think, with respect, that I was sticking very closely to the Financial Resolution. I am not dealing with points of principle raised on the Second Reading. I am trying to deal with the financial consequences of the principles approved on the Second Reading of the Bill.

The Deputy-Chairman: The Financial Resolution does not deal with consequences, but with provisions.

Sir W. Wakefield: The hon. Member for Nelson and Colne (Mr. S. Silverman) made a statement a little earlier, and I understood from your predecessor in the Chair that it would be in Order to discuss the financial consequences of principles approved in the Second Reading.

The Deputy-Chairman: I cannot allow this point to be discussed. I have given a Ruling, and the hon. Member will please accept it.

Sir W. Wakefield: Thank you, Mr. Beaumont. I pass on to my final point on this Financial Resolution. Could the Minister state under what paragraph payment will be made to people who are now engaged in the work of staffs of hospital contributory schemes? That work has to go on, and it relates very much to the points raised by the hon. Member for Huntingdon (Mr. Renton) as to the unavoidable delay in bringing this Measure into operation. This affects certain sections of people now working in connection with the hospitals, and it is causing anxiety among them. Could the Minister say whether, under the Financial Resolution, provision is made, and also under what heading, in order that compensation may be paid, or continuity of work provided?

The Deputy-Chairman: Unless the hon. Member can indicate to me where in the Financial Resolution this point arises, I will not be able to allow the Minister to reply, even if he wishes to do so.

Sir W. Wakefield: I thank you, Mr. Beaumont, and I have been trying to find under which paragraph of the Financial Resolution this provision could be made.

The Deputy-Chairman: If the hon. Member cannot find it, I certainly cannot help him, and he cannot continue.

Sir W. Wakefield: I conclude by saying I cannot think that the Minister can be so hard hearted as not to make provision for these people under this Financial Resolution.

Mr. Moyle (Stourbridge): I want to raise one or two points under paragraph (g) of the Money Resolution, which are related to Clause 63 of the Bill. As the Minister knows there are other bodies of health workers affected by this Bill besides doctors. I would like to be clear on what the position of these health workers will be, when they become employees of the regional boards. There are gaps to be filled in this sphere of superannuation, which are as urgent to the welfare of the scheme as are matters in the field of medicine. Two things are required if the Minister is to obtain an efficient nursing service. There has to


be mobility of labour as between one hospital and another, and if the Minister wants, as I know that he does, an efficient nursing profession, there will have to be interchangeability from one hospital to another. I would like to ask the Minister whether in the event of nurses wanting to qualify—

8.30 p.m.

The Deputy-Chairman: The point which the hon. Member is raising should be raised in Committee, not now.

Sir W. Wakefield: Further to your Ruling, Mr. Beaumont—

The Deputy-Chairman: I have not called upon the hon. Gentleman. Does the hon. Member wish to raise a point of Order?

Sir W. Wakefield: On a point of Order. Further to the Ruling you have just given, I understand that the hon. Member for Stourbridge (Mr. Moyle) was trying to make the same point as I was, that this matter is covered by paragraph (d).

The Deputy-Chairman: The hon. Member will have observed that the hon. Member for Stourbridge was no more successful than he was.

Sir W. Wakefield: You asked me, Mr. Beaumont, if I could indicate on which paragraph I was speaking. I do so now; it was paragraph (d).

The Deputy-Chairman: I asked the hon. Member that question some time ago, and he could not then indicate with which paragraph he was dealing. He cannot raise the matter again.

Mr. Moyle: I apologise for detaining the Committee. I shall try again and perhaps meet with greater success. The Minister proposes in the Bill—and paragraph (d) of the Money Resolution provides the expenses—to amend, in certain conditions, the Superannuation Act of 1937. To the regional board will come bodies of health workers, nurses who are subject to certain superannuation schemes and certain insurance policies, and who will carry with them certain acquired rights under existing superannuation law. I wish to ask the Minister whether he has provided in this Money Resolution sufficient financial scope to enable him to maintain the existing superannuation

rights, endowment assurance rights, which have been acquired by nurses under the federated insurance schemes of the voluntary hospital managements. For example, the acquired rights of mental nurses under the Asylum Officers' Superannuation Act and the rights of Class I Nurses under that Act entitle them, in certain circumstances, to retire at 55. Will this paragraph of the Money Resolution provide sufficient money to enable him to maintain those rights of such service under these various Superannuation Acts and insurance policies, if and when those concerned are brought under the Superannuation Act of 1937? In other words, will there be a continuity of rights on transfer from their existing managements to the new employer provided under this Bill, the Regional Board? Secondly, assuming for a moment that there are nurses—and there are hundreds of them—

The Deputy-Chairman: I hesitate to rule the hon. Member out of Order, but I really think that the point with which he is dealing could be dealt with much more suitably on the Committee stage.

Mr Moyle: I bow to you Ruling, Mr. Beaumont, but I wish to raise these points, because I desire some clarification in this matter. I do not want to find, when the matter reaches the Committee stage, that I am ruled out of Order, in view of the fact that money is not provided for the particular matters with which I am concerned.

The Minister of Health (Mr. Aneurin Bevan): I am suffering under a considerable disability, because so many questions which are out of Order have been aimed at me, and I would be out of Order at once if I attempted to reply. I hope that hon. Members who have been making most engaging efforts to keep themselves in Order will forgive me if I am unable to make any reference to their exertions. I have, however, been asked one or two questions which were in Order, and I am delighted to have an opportunity to reply. My hon. Friend the Member for East Islington (Mr. E. Fletcher) made reference to the difficulties of severance in the transfer of hospitals and other equipment from local authorities. It will be difficult in many instances to establish the line of demarcation, especially when the funds of the hospitals are merged in a general


local government fund. It may not be possible always to identify a particular sum of money. Where there is a loan outstanding against a hospital the position is perfectly clear. The obligation of the loan will be taken over with the hospital itself. Where the hospital has been constructed and paid for out of revenue, I am afraid there is no redress at all. We shall just have to take it. Reference was also made to the alteration which will be necessary in the block grant—

Mr. House (St. Pancras, North): Would the Minister deal with the point whether, in the event of difference between the local authority and the Minister, arbitration might be available?

Mr. Bevan: That is, of course, an entirely different question. I think it is a matter that could quite properly be dealt with in Committee. It is not invalidated by the Financial Resolution, if the Resolution is carried. However, I am perfectly prepared to consider the question. I hope the relations between the Minister of Health and the local authorities are so cordial that it will not be necessary to go to arbitration over any dispute. It is obvious that the taking over of this obligation from the local authorities will materially disturb the financial relations between the local authorities and the Exchequer. The block grant itself will have to be revised. In fact, the block grant would have to be revised in any case. In the revision the services transferred to the Exchequer under this Bill and the new services created by the counties and county boroughs will materially affect the distribution of the block grant. I propose to start discussions almost immediately with representatives of the local authorities to try and get the new block grant formula agreed.
Reference has been made to what is to happen in the meantime to the voluntary hospitals. That is a very important question indeed. One of the inevitable consequences of a Measure of this sort is that there is an interregnum between the passing of the Act and the establishment of the new service. Therefore, I hope that all those concerned with voluntary hospitals will maintain their exertions. I imagine that the weekly contributions will be paid until they are no longer necessary. I hope the various voluntary hospital activities will be carried on.

Furthermore, I trust that the contributions of the public will be kept up to enable the services of the voluntary hospitals to be maintained at the highest possible standard until the new service is established.

Mr. Renton: I am sure the Committee is grateful to the Minister for his clarification of this matter. What it amounts to is that the voluntary hospitals will not in the interregnum receive any financial assistance other than that which already they are entitled to receive, and that they will continue to remain dependent upon charitable subscriptions. Will the Minister take every step that he can to help in this respect and to give publicity to the need which he has mentioned? Otherwise these hospitals may feel the draught.

Sir W. Wakefield: That was the point I was trying to make about the hospital savings association from which comes so much of the voluntary hospital funds.

Mr. Bevan: I am glad that I have had the opportunity to make the matter public on this way. I certainly will take advantage of other opportunities to make it clear to the public that hospital services would gravely deteriorate unless contributions are maintained in the meantime and the whole machinery kept up to date. The hon. Member for St. Marylebone (Sir W. Wakefield) asked one question which was, I believe, either in Order or on the frontiers of being in Order, though I am not certain which side of the frontier it was. He asked whether it would be possible for a general practitioner to use the health centre for his private patients and to use the equipment of the health centre. The answer is, "No." It would be wholly unacceptable that we should provide public money in order to enable the general practitioner to obtain fees from persons who would normally be entitled to avail themselves of these services freely, and I think that all hon. Members would agree that this is a perfectly proper conclusion. I am unable to answer the question on superannuation, but I should be delighted to do so on a further occasion. I hope that, with these observations, the Committee will allow me to have the Money Resolution.
Question put, and agreed to.
Resolution to be reported upon Monday next.

EDUCATION BILL

Order read for Consideration of Lords Amendments.

Ordered: "That the Lords Amendments be now considered."—[Mr. Hardman.]

Lords Amendments considered accordingly.

CLAUSE 2.—(Division of a single school into two or more schools.)

Lords Amendment: In page 2, line 35, after "order," insert:
by virtue of which a school is an aided school.

8.42 p.m.

The Parliamentary Secretary to the Ministry of Education (Mr. Hardman): I beg to move, "That this House doth agree with the Lords in the said Amendment."
This Amendment is being made in order to clarify the expression "order" in line 35.
Question put, and agreed to.
CLAUSE 10.—(Qualification of teachers for membership of local authorities and their committees.)
Lords Amendment: In page 5, line 28, leave out from "teacher" to "by," in line 29, and insert:
'in, or being otherwise employed in, any school college or other educational institution maintained or assisted".

Mr. Hardman: I beg to move, "That this House doth agree with the Lords in the said Amendment."
The object of this Amendment is to enable such employees of local education committees as wardens of youth centres and organisers, to serve on education committees as well as ordinary teachers. We feel that the same rights ought to apply to them.
Question put, and agreed to.
CLAUSE 12.—(Compensation for certain officers of county councils.)
Lords Amendment: In page 6, line 33, leave out from beginning to "any," in line 36, and insert:
if as a result of any action taken by the council of a county in consequence of the fact that any of their functions relating to education are, or are to be, exercised in accordance with a scheme of divisional administration,".

Mr. Hardman: I beg to move, "That this House doth agree with the Lords in the said Amendment."
The object of this Amendment is to limit the operation of the Clause. It was intended to cover those officers of a county council who have suffered direct financial loss.
Question put, and agreed to.

SECOND SCHEDULE.—(Miscellaneous Amendments of Principal Act.)

Lords Amendment: In page 16, line 54, at end, insert:
Section thirty-four At the end of subsection (4) there shall be inserted the words "unless the parent makes suitable arrangements for the provision of such treatment for the child otherwise than by the authority.
In subsection (6), for the words "cease to provide" there shall be substituted the words "if they are providing"; and after the word "issued," where that word secondly occurs, there shall be inserted the words "shall cease to provide such treatment for the child".

Mr. Hardman: I beg to move, "That this House doth agree with the Lords in the said Amendment."
The purpose of this Amendment is to make it clear that a local education authority is under no obligation to provide special educational treatment themselves in any case where they are satisfied that such treatment is being given satisfactorily by the parents.
Question put, and agreed to.
Remaining Lords Amendments agreed to (Several with Special Entries).

POST OFFICE AND TELEGRAPH [MONEY]

Resolution reported:
That, for the purposes of any Act of the present Session, to provide for raising further money for the development of the postal, telegraphic and telephonic systems and the repayment to the Post Office Fund of moneys applied thereout for such development, it is expedient—

to authorise the payment out of the Consolidated Fund of such sums, not exceeding in the whole fifty million pounds, as may be required for the purposes of such development or of such repayment;


to authorise the Treasury to borrow, by means of terminable annuities or by the issue of Exchequer Bonds, for the purpose of providing money for sums so authorised to be issued or of repaying to the Consolidated Fund all or any part of the sums so issued and to authorise the payment into the Exchequer of any sums so borrowed;
to provide for the payment of such terminable annuities, or of the principal of and interest on any such Exchequer Bonds, out of moneys provided by Parliament for the service of the Post Office, or, if those moneys are insufficient, out of the Consolidated Fund."


Resolution agreed to.

POST OFFICE AND TELEGRAPH (MONEY) BILL

Considered in Committee; reported, without Amendment; read the Third time, and passed.

ADJOURNMENT

Resolved: "That this House do now adjourn."—[Mr. R. J. Taylor.]

Adjourned accordingly at Nine Minutes to Nine o'Clock